The role of adherence on the effectiveness of nonpharmacologic interventions - Evidence from the delirium prevention trial
The role of adherence on the effectiveness of nonpharmacologic interventions - Evidence from the delirium prevention trial
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DOI：
10.1001/archinte.163.8.958
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发表时间：
2003-04-28
影响因子：
--
通讯作者：
Agostini, JV
中科院分区：
文献类型：
--
作者：
Inouye, SK;Bogardus, ST;Agostini, JV
背景：非药物干预策略的依从性对结果的影响以前没有被研究过。目的：在一项大型的非药物干预预防妄想的临床试验中，检查依从性水平对干预策略有效性的影响。方法：研究对象包括422名在大学医院就诊的70岁或以上的连续患者。干预方案针对6个妄想危险因素。结果：在9882个病人日中，个体干预方案的完全依从率从睡眠方案的10%到定向方案的86%不等。所有方案的完全依从率为57%，部分和完全依从率为87%。依从性水平越高，定向、活动和治疗活动方案以及复合依从性测量的妄想率就越低，并有显著的分级效应。在控制了潜在的混杂变量，如疾病严重程度、合并症、基线精神错乱风险和功能状态后，依从性继续显示出对精神错乱的一贯强烈和显著的保护作用(调整后的优势比为0.69；95%可信区间为0.56-0.87)。与最低依从性组患者相比，依从性最高组患者的精神障碍风险降低了89%。结论：依从性在非药物多组分干预策略的有效性中起着重要的独立作用。更高水平的依从性导致直接分级的痴呆率降低，最高依从性组的神志错乱水平极低。因此，在非药物干预中必须确保依从性，以优化有效性。
Background: The impact of adherence on outcome for a nonpharmacologic intervention strategy has not been previously examined.Objective: To examine the impact of level of adherence on effectiveness of the intervention strategy in a large clinical trial of nonpharmacologic interventions to prevent delirium.Methods: The subjects included 422 consecutive patients 70 years or older admitted to the medicine service at a university hospital. The intervention protocols were targeted toward 6 delirium risk factors. The primary outcome was new-onset delirium during hospitalization.Results: During 9882 patient-days, complete adherence rates for individual intervention protocols ranged from 10% for the sleep protocol to 86% for the orientation protocol. The rate of complete adherence with all protocols was 57%, and combined partial and complete adherence was 87%. Higher levels of adherence resulted in lower delirium rates, with a significant graded effect, for orientation, mobility, and therapeutic activities protocols, and for the composite adherence measure. After controlling for potential confounding variables, such as illness severity, comorbidity, baseline delirium risk, and functional status, adherence continued to demonstrate a consistently strong and significant protective effect against delirium (adjusted odds ratio, 0.69; 95% confidence interval, 0.56-0.87). Patients in the highest adherence group demonstrated an 89% reduction in delirium risk compared with patients in the lowest group.Conclusions: Adherence played an important independent role in the effectiveness of a nonpharmacologic multicomponent intervention strategy. Higher levels of adherence resulted in reduced rates of delirium in a directly graded fashion, with extremely low levels of delirium in the highest adherence group. Thus, adherence must be ensured in nonpharmacologic interventions to optimize effectiveness.