养老机构冠心病患者服药依从性现状及影响因素

采用Morisky推荐的MAQ对锦州市养老机构中153名冠心痛患者的服药依从性进行测评,探讨冠心病患者的服药依从性现状及影响因素.结果显示,养老机构冠心病患者服药依从性差的比率为81.7％,影响服药依从性的因素为文化程度、服药种类、医疗背景、入住年限.养老机构的护理人员应对上述因素给予更多的关注,从而提高其服药依从性,进而提升其临床治疗效果.     

初治肺结核患者服药依从性的相关因素分析

为了了解初治肺结核患者服药依从性状况及影响因素,采用分层整群随机抽样方法抽取样本,利用自制调查表和Morisky依从性量表获取数据信息,并用SPSS 16.0软件进行统计分析.参与调查的578例初治肺结核患者中,依从性低组为194例,占33.6％,依从性正常组为384例,占66.4％.影响服药依从性的主要因素为职业、治疗时期、生活满意度、病情严重程度等（P＜0.05）.可见初治肺结核患者不规则服药受多方面因素影响,应加强各方督导,提高服药依从性.     

动机谈话对高血压患者治疗依从性的影响

探讨动机谈话对高血压患者治疗依从性的影响.采用实验对照研究方法,采用动机谈话对高血压患者治疗依从性进行干预.结果干预组患者在服药、体力活动等依从性方面优于对照组.结论是动机谈话在改善患者治疗依从性方面是一种比较有效的干预措施.     

规范化治疗体系对抑郁症治疗依从性的干预研究探讨

抑郁症的药物治疗是一个长期的过程,因此治疗依从性极其重要,然而,因疾病特点、药物、医患等多方面原因,导致治疗依从性较差,如何提高治疗依从性成为备受关注的问题。国内外相关研究较多,其中系统规范的随诊模式,抑郁症及药物知识的教育,心理治疗及对家庭成员相关知识的教育干预等均被证实确实有效。本文就各种干预方法进行探讨,以期确立系统规范的随诊、治疗体系,提高治疗依从性。     

结核患者服药依从性的研究现状

结核病控制是全球卫生工作的一个重点,服药依从性则是其中关键的一环。本文对结核患者服药依从性的重要性、影响因素及提高依从性的措施进行综述,认为实施直接督导短程化疗（DOTS）、强化督导、改善患者对服药依从性的认识、简化给药方案、减轻患者经济负担、设置患者提醒物等可提高服药依从性。     

结核患者服药依从性的研究现状

结核病控制是全球卫生工作的一个重点，服药依从性则是其中关键的一环。本文对结核患者服药依从性的重要性、影响因素及提高依从性的措施进行综述，认为实施直接督导短程化疗（DOTS）、强化督导、改善患者对服药依从性的认识、简化给药方案、减轻患者经济负担、设置患者提醒物等可提高服药依从性。     

社区高血压患者心理一致感与服药依从性的关系研究

为了解社区高血压患者心理一致感及服药依从性现状,并探讨二者关系,本研究采用心理一致感量表、Morisky服药依从性量表对济南市214例社区高血压患者进行调查.结果显示,社区高血压患者服药依从性良好率仅为18.7％;心理一致感总分为58.78±10.44,处于中等水平,各维度条目均分由低至高依次为可理解感(4.36±0.94)、可控制感(4.47±1.00)及意义感(4.77±0.94);不同心理一致感水平的患者其服药依从性差异具有统计学意义(P＜0.01),高心理一致感的患者服药依从性最好,且心理一致感是患者服药依从性的保护性因素.因此,社区高血压患者的心理一致感能够影响其服药依从性,故应重视患者心理一致感的培养,以改善服药依从性.     

综合医院抑郁症和神经症诊疗决策的思考

抑郁症和神经症是一种慢性易复发性精神疾病,发病率高,疾病负担重,多数患者都就诊于综合医院非精神专科,而目前的现状是综合医院的各科医生对此类疾病的识别率低、治疗率低,患者依从性差。结合临床提出了关于综合医院如何提高抑郁症和神经症的识别率,医生在精神疾病诊疗中应注意的问题以及如何提高患者治疗依从性等临床亟待解决的问题。     

综合医院抑郁症和神经症诊疗决策的思考

抑郁症和神经症是一种慢性易复发性精神疾病,发病率高,疾病负担重,多数患者都就诊于综合医院非精神专科,而目前的现状是综合医院的各科医生对此类疾病的识别率低、治疗率低,患者依从性差.结合临床提出了关于综合医院如何提高抑郁症和神经症的识别率,医生在精神疾病诊疗中应注意的问题以及如何提高患者治疗依从性等临床亟待解决的问题.     

睡眠时型与抑郁的关系及其机制

抑郁症不仅严重影响个体的身心健康,也加大了医疗保健的负担,已成为全球关注的公共卫生问题。众多研究表明昼夜节律紊乱与抑郁症显著相关,使睡眠时型成为探讨抑郁发生和发展的一个新视角。睡眠时型包括清晨型、中间型和夜晚型。夜晚型是抑郁的风险因素,清晨型则是其保护性因素。情绪调节行为机制和杏仁核、扣带回皮质等神经机制的探讨,可以帮助我们更好理解睡眠时型对抑郁的影响。未来研究还需要探索睡眠时型的多维结构,增加前瞻性队列研究设计,丰富心理和生理机制,加强干预性的实证研究。     

Conscientiousness and adherence to the oral contraceptive pill: a cross-sectional analysis of the facets of conscientiousness

We examine the association between a six-facet model of conscientiousness and adherence to the Oral Contraceptive Pill (OCP), to investigate if these 6 facets can account for variation in adherence to the OCP. Cross-sectional data were collected from an opportunity sample of 243 female participants who were current users of the OCP, via online survey. Data were analysed using correlation and standard regression. The 60-item Chernyshenko Conscientiousness Scale (CCS), the 10-item IPIP Conscientiousness (IPIP C) subscale and the 5-item OCP Medication Adherence Report Scale (MARS) were employed. Both the total CCS (ρ = ?0.26, p < 0.01) and the IPIP C scale (ρ = ?0.22, p < 0.01) were associated with MARS. All facets measured by the CCS had small to medium-sized statistically significant correlations (r > ?0.18 and r < ?0.23, p < 0.05) with OCP adherence with the exception of traditionalism. Within a multivariable model, the six facets accounted for 7.1% of variance (p < 0.01) in adherence to the OCP. No one facet made a significant unique contribution to the model. These findings replicate and extend previous links between conscientiousness and OCP adherence. Further research should be conducted to establish the reliability of these findings in a general population of OCP users. Future interventions should focus on the development of interventions which take conscientiousness into consideration.     

Adherence predictors in an Internet-based Intervention program for depression

Internet-delivered psychotherapy has been demonstrated to be effective in the treatment of depression. Nevertheless, the study of the adherence in this type of the treatment reported divergent results. The main objective of this study is to analyze predictors of adherence in a primary care Internet-based intervention for depression in Spain. A multi-center, three arm, parallel, randomized controlled trial was conducted with 194 depressive patients, who were allocated in self-guided or supported-guided intervention. Sociodemographic and clinical characteristics were gathered using a case report form. The Mini international neuropsychiatric interview diagnoses major depression. Beck Depression Inventory was used to assess depression severity. The visual analogic scale assesses the respondent’s self-rated health and Short Form Health Survey was used to measure the health-related quality of life. Age results a predictor variable for both intervention groups (with and without therapist support). Perceived health is a negative predictor of adherence for the self-guided intervention when change in depression severity was included in the model. Change in depression severity results a predictor of adherence in the support-guided intervention. Our findings demonstrate that in our sample, there are differences in sociodemographic and clinical variables between active and dropout participants and we provide adherence predictors in each intervention condition of this Internet-based program for depression (self-guided and support-guided). It is important to point that further research in this area is essential to improve tailored interventions and to know specific patients groups can benefit from these interventions.     

A Cognitive Behavioral Adherence Intervention for Adolescents with Type 1 Diabetes

This study examined the impact of a cognitive behavioral intervention for nonadherent adolescents with type 1 diabetes. Six youths having problems following the diabetes regimen received training in cognitive restructuring and problem solving during individual sessions. A multiple baseline design across participants was used. Treatment effectiveness was assessed through 24-hr recall adherence interviews with adolescents and frequency of testing data was downloaded from glucose meters. Data was also collected for diabetes-specific stress. Five youths displayed improvement on at least one self-care behavior. Furthermore, the results suggest that the cognitive behavioral intervention was effective in diminishing diabetes-related stress in two participants. Cognitive behavioral interventions show promise for increasing self-care behaviors among nonadherent youths with type 1 diabetes. However, individual youths varied in their response to treatment. Further research is needed in developing procedures to better meet the needs of youths, improve youth participation, and enhance treatment effectiveness.     

Predictors of Adherence to a Brief Behavioral Insomnia Intervention: Daily Process Analysis

Behavioral interventions for insomnia are effective in improving sleep, yet adherence is variable, and predictors of adherence have not been consistently replicated. The relationships between daily variations in state factors at the initiation of treatment and adherence have not been investigated. Using 2-week, self-report online logs, this study determined, among 53 college students with probable insomnia, the associations of pretreatment factors and daily factors during treatment on daily variations in adherence to one session of behavioral treatments for insomnia. These treatments included stimulus control therapy (SCT), sleep restriction therapy (SRT), and sleep hygiene (SH). Low self-efficacy was associated with poorer SCT and SH adherence. Participants with a “bed partner or pet” at least some of the time had better SCT adherence. Greater total sleep time and poorer sleep quality were associated with poor SCT and SRT adherence the following night. Greater sleep efficiency was related to greater next night SCT and SRT adherence. Alcohol consumption was related to poorer SRT and SH adherence the following night. Future studies should test the replicability of these findings. Adherence trials may want to test whether discouraging alcohol intake, enhancing treatment-related self-efficacy, and monitoring and providing feedback on sleep, early in treatment, affects adherence.     

Treatment Adherence in Children with Sickle Cell Disease: Disease-Related Risk and Psychosocial Resistance Factors

To identify disease-related risk factors and psychosocial resistance factors that impact adherence to prescribed treatment in the context of admission to a Hematology Acute Care Unit (HACU) designed to provide acute care for children with sickle cell disease (SCD) presenting with pain or fever. A total of 73 primary caregivers and 24 children (if age 8 or older) completed standardized forms during the HACU admission. Treatment adherence variables (medical staff rating, SCD-related care activities, percentage of agreement between treatment recommendations made and care activities, and attendance at hematology clinic) indicated moderate-to-high adherence. Based on regression analyses, the risk variable of disease-related stress and the resistance variables of family flexibility and less reliance on passive coping accounted for significant portions of the variance in treatment adherence. Empirical evaluation of interventions designed to improve communication regarding expectations for the care of children with SCD and to support active family problem solving during times of SCD-related stress must be ongoing.     

Resilience,religiosity and treatment adherence in hemodialysis patients: a prospective study

Resilience and religiosity have received attention as an important process in the experience and management of chronic comorbidities; however, there is no study evaluating resilience in hemodialysis patients and its association with other psychological dimensions or with treatment adherence. This observational prospective study assessed resilience (25 item Wagnild and Young Resilience Scale), religiosity under three dimensions (organizational, non-organizational and intrinsic) using DUREL scale, depressive symptoms (Patient Health Questionnaire-9) and health-related quality of life (Short Form-36 questionnaire). The main outcomes were medication adherence using the Morisky Medication Adherence Scale-8 (MMAR-8) and the missing/shortened dialysis sessions in the following six months. Of 208 patients approached, 202 (97.1%) agreed to participate. One hundred twenty-three patients (60.9%) were males and mean age was 52.8 ± 14.8 years-old. The median time on hemodialysis was 36 months (IQR, 12, 84). 82 (40.6%) patients obtained a MMAS-8 score <6 and were considered as having ‘poor adherence’. Overall, the mean score of medication adherence was low (5.7 ± 2.1). About adherence to hemodialysis sessions, patients missed a total of 234 (1.6%) hemodialysis sessions. Forty-eight patients (23.7%) missed an average of at least three sessions in six months. Regarding adherence to medication, there was no association in the uni- or multivariate analysis between religiosity dimensions and MMAS-8 score. After adjustment, resilience was positively associated with MMAS-8 score (standardized β coefficient .239, p = .016). Organized and intrinsic religiosity were associated with adherence to dialysis sessions (standardized β coefficient .258, p = .004 and .231, p = .026, respectively). Interestingly, opposite to medication adherence, more resilient patients were associated with less adherence to hemodialysis sessions (standardized β coefficient ?.296, p = .001). Religiosity was associated with dialysis adherence but not with medication adherence. Resilience was associated with higher medication adherence but lower adherence to dialysis sessions.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

Medication beliefs and structural barriers to treatment adherence among people living with HIV infection

Background: People living in poverty face multiple structural challenges to medication adherence including lack of transportation, inadequate housing and food insecurity. The degree to which individuals’ motivations to remain adherent may overcome structural barriers has received limited attention.

Purpose: To examine whether medication necessity and concerns beliefs predict antiretroviral therapy (ART) adherence over and above structural adherence barriers associated with poverty.

Methods: People living with HIV in a southern US city (N = 942) completed computerised interviews, an objective measure of adherence and HIV viral suppression obtained from medical records. Hierarchical logistic regression models were constructed to examine demographic and illness characteristics, structural barriers, mental health, substance use and medication necessity and concerns beliefs as predictors of ART adherence.

Results: In multivariable models, current drug use and medication necessity and concerns beliefs predicted treatment adherence over and above demographic, health, mental health and structural factors.

Conclusions: Medication beliefs are proximal and powerful motivating factors that predict adherence. Adherence interventions should directly address medication beliefs in developing strategies to manage barriers facing people with HIV living in poverty.     

Contextual Intervention for Caregiver Non-Adherence With Behavioral Intervention Plans

The extent to which parents and other caregivers implement behavioral interventions with integrity has an important impact on treatment effectiveness. This article considers popular interventions that train caregivers and improve treatment integrity in applied behavior analysis. After considering these interventions a contextual approach is described, whereby the function of caregiver non-adherence is considered. In particular, interventions aimed at manipulating setting factors are reviewed. The examples of respite and social support groups are provided as function-based interventions to improve caregiver adherence to behavioral recommendations. Implications for more contextual, coordinated, and comprehensive function-based behavioral services are provided.     

Assessing theoretical predictors of long-term medication adherence: Patients’ treatment-related beliefs,experiential feedback and habit development

Patient non-adherence to medication is a pervasive problem that contributes to poor patient health and high healthcare costs. Basic research and interventions have focused thus far on behaviour initiation factors, such as patients’ illness and treatment beliefs. This paper proposes two processes that occur after behaviour initiation that are theorised to contribute to prediction of long-term medication adherence: ‘coherence’ of patients’ beliefs from experiences with treatment and habit development. Seventy-one hypertensive patients reported their treatment-related beliefs, experiences related to treatment efficacy and medication-taking habit strength in a baseline interview. Patients then used an electronic monitoring pill bottle for approximately one month. Patients’ medication habit-strength was the strongest predictor of all adherence measures, explaining 6–27% incremental variance in adherence to that explained by patients’ treatment-related beliefs. Patients’ beliefs and experiences did not predict overall adherence, even for patients with ‘weaker’ habits. However, patients’ experiences were found to predict intentional non-adherence and habit strength was found to predict unintentional adherence. Practitioners may assess patients’ medication-taking habits to get an initial view of their likely adherence to long-term medications. Future research should assess the current theoretical predictions in a hypertension inception sample and in populations with symptomatic conditions.