Guideline implementation and patient-tailoring strategies to improve medication adherence for schizophrenia
Guideline implementation and patient-tailoring strategies to improve medication adherence for schizophrenia
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DOI：
10.4088/jcp.v69n0110
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发表时间：
2008-01-01
影响因子：
5.3
通讯作者：
Thapa, Purushottam
中科院分区：
文献类型：
--
作者：
Hudson, Teresa J.;Owen, Richard R.;Thapa, Purushottam
目的：为了确定有效的干预措施，以促进药物adherence.Method：数据收集的成年人与精神分裂症的恶化谁是在美国退伍军人事务部（VA）医疗中心（VAMCs）的3个区域VA网络（退伍军人综合服务网络[VISNs]），从1999年3月至2000年10月治疗。所有6个VAMC接受了精神分裂症药物管理的基本指南实施策略，使用常规VA程序。在每个VISN中随机选择一个VAMC接受增强的实施策略，旨在促进医生处方的指南一致性和患者的药物依从性。在增强策略中，研究护士与研究参与者合作，以确定药物依从性障碍，并制定针对患者的策略来克服这些障碍。参与者（N = 349）在入组时和6个月后进行了访谈，使用阳性和阴性症状量表（PANSS），巴恩斯静坐不能评定量表和精神分裂症结局模块（SCHIZOM）的结构化临床访谈。通过受试者的自我报告，使用SCHIZOM，并从数据提取的医疗records.Results：参与者主要是男性（94%）和非白人（69%，主要是非洲裔美国人），平均年龄为46岁。随访时的药物依从性采用logistic回归建模，控制基线依从性、人口统计学特征、PANSS总分、基线静坐不能、精神疾病家族史和药物滥用。随访时依从性的logistic回归模型具有显著性（似然比= 52.72，df = 14 p < .0001）。在接受强化干预的研究中心入组的患者在随访时依从性的可能性几乎是其两倍。基线时未依从的患者在随访时依从的可能性显著降低。此外，在后续的坚持是显着更大的VA网络相比，第三个network.Conclusions：这些数据表明，以患者为中心的策略，以确定和克服的障碍，坚持可以提高抗精神病药物的依从性。
Objective: To determine the effectiveness of an intervention to promote medication adherence.Method: Data were collected for adults with exacerbation of schizophrenia who were treated at one of 6 U.S. Department of Veterans Affairs (VA) Medical Centers (VAMCs) in 3 regional VA networks (Veterans Integrated Service Networks [VISNs]) from March 1999 to October 2000. All 6 VAMCs received a basic guideline implementation strategy for medication management of schizophrenia using usual VA procedures. One VAMC within each VISN was randomly selected to receive an enhanced implementation strategy designed to promote guideline-concordain prescribing by physicians and medication adherence by patients. In the enhanced strategy, a research nurse worked with study participants to identify medication adherence barriers and to develop patient-specific strategies to overcome those barriers. Participants (N = 349) were interviewed at enrollment and 6 months later, using the Structured Clinical Interview for the Positive and Negative Syndrome Scale (PANSS), the Barnes Akathisia Rating Scale and the Schizophrenia Outcomes Module, (SCHIZOM). Medication adherence was measured via subjects' self-report, using the SCHIZOM, and from data abstracted from medical records.Results: Participants were primarily male (94%) and nonwhite (69%, primarily African American) with a mean age of 46 years. Medication adherence at follow-up was modeled using logistic regression, controlling for adherence at baseline, demographic characteristics, PANSS total score, akathisia at baseline, family history of mental illness, and substance abuse. A logistic regression model for adherence at follow-up was significant (likelihood ratio = 52.72, df = 14 p < .0001). Patients enrolled at sites receiving the enhanced intervention were almost twice as likely to be adherent at follow-up. Those who were nonadherent at baseline were significantly less likely to be adherent at follow-up. In addition, adherence at follow-up was significantly greater at 2 of the VA networks as compared to the third network.Conclusions: These data suggest that a patient-centered strategy to identify and overcome barriers to adherence can improve adherence to antipsychotic medications.