Strategies for enhancing patient compliance.
Strategies for enhancing patient compliance.
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DOI：
10.1007/bf01318980
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发表时间：
1980-01-01
影响因子：
5.9
通讯作者：
Maiman, L A
中科院分区：
文献类型：
--
作者：
Becker, M H;Maiman, L A
患者的不依从性是实现治疗目标的重要障碍。本文综述了一些在提高患者依从性方面被证明有效的实际干预措施，包括(1)提高患者关于其方案细节的信息水平，通过回顾、讨论和书面指导来强化要点，并强调治疗计划的重要性，(2)采取临床上适当的步骤来降低方案所需的成本、复杂性、持续时间和数量，并通过“量身定制”和其他方法增加方案的便利性，(3)获得患者以前的经验和目前的健康信念的依从性历史，并在必要时采用策略来改变那些可能抑制依从性的看法，(4)提高患者满意度，特别是对供方与患者之间的关系；(5)安排继续监测患者随后的治疗依从性；(6)提高工作人员对不依从现象的严重性和决定因素的认识，并试图在医疗团队的每个成员中培养“积极影响导向”；(7)使用诸如患者-提供者合同等技术，让患者参与治疗决定和治疗目标的制定，并为实现这些目标创造激励(通过奖励和加强)；(8)安排尽可能多的提供者(和其他工作人员)的连续性；(9)建立监督病人的方法，包括病人的社会支持网络的参与，以及(10)充分利用所有现有保健提供者的协助，为旨在改善治疗依从性的活动指定具体的角色和责任。
Patient noncompliance is a substantial obstacle to the achievement of therapeutic goals. This paper reviews a number of practical interventions with demonstrated efficacy in enhancing patient adherence, including (1) improving patients' levels of information concerning the specifics of their regimens, reinforcing essential points with review, discussion, and written instruction, and emphasizing the importance of the therapeutic plan, (2) taking clinically appropriate steps to reduce the cost, complexity, duration, and amount of behavioral change required by the regimen and increasing the regimen's convenience through "tailoring" and other approaches, (3) obtaining a compliance-oriented history of the patient's prior experiences and present health beliefs and, where necessary, employing strategies to modify those perceptions likely to inhibit compliance, (4) improving levels of patient satisfaction, particularly with the provider-patient relationship, (5) arranging for the continued monitoring of the patient's subsequent compliance to treatment, (6) increasing staff awareness of the magnitude and determinants of the noncompliance phenomenon and attempting to develop an "active influence orientation" in each member of the health care team, (7) using such techniques as patient-provider contracts to involve the patient in therapeutic decisions and in the setting of treatment objectives and creating incentives (through rewards and reinforcements) for achieving these objectives, (8) arranging for as much continuity of provider (and other staff) as possible, (9) establishing methods of supervising the patient, including involvement of the patient's social support network, and (10) involving fully the assistance of all available health care providers, assigning specific roles and responsibilities for activities directed at improving adherence to treatment.