Sevick M A, Levine D W, Burkart J M, Rocco M V, Keith J, Cohen S J
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1063, USA.
Perit Dial Int. 1999 Jan-Feb;19(1):23-30.
The purpose of the study was to test a novel approach to monitoring the adherence of continuous ambulatory peritoneal dialysis (CAPD) patients to their dialysis prescription.
A descriptive observational study was done in which exchange behaviors were monitored over a 2-week period of time.
Patients were recruited from an outpatient dialysis center.
A convenience sample of patients undergoing CAPD at Piedmont Dialysis Center in Winston-Salem, North Carolina was recruited for the study. Of 31 CAPD patients, 20 (64.5%) agreed to participate.
Adherence of CAPD patients to their dialysis prescription was monitored using daily logs and an electronic monitoring device (the Medication Event Monitoring System, or MEMS; APREX, Menlo Park, California, U.S.A.). Patients recorded in their logs their exchange activities during the 2-week observation period. Concurrently, patients were instructed to deposit the pull tab from their dialysate bag into a MEMS bottle immediately after performing each exchange. The MEMS bottle was closed with a cap containing a computer chip that recorded the date and time each time the bottle was opened.
One individual's MEMS device malfunctioned and thus the data presented in this report are based upon the remaining 19 patients. A significant discrepancy was found between log data and MEMS data, with MEMS data indicating a greater number and percentage of missed exchanges. MEMS data indicated that some patients concentrated their exchange activities during the day, with shortened dwell times between exchanges. Three indices were developed for this study: a measure of the average time spent in noncompliance, and indices of consistency in the timing of exchanges within and between days. Patients who were defined as consistent had lower scores on the noncompliance index compared to patients defined as inconsistent (p = 0.015).
This study describes a methodology that may be useful in assessing adherence to the peritoneal dialysis regimen. Of particular significance is the ability to assess the timing of exchanges over the course of a day. Clinical implications are limited due to issues of data reliability and validity, the short-term nature of the study, the small sample, and the fact that clinical outcomes were not considered in this methodology study. Additional research is needed to further develop this data-collection approach.
本研究旨在测试一种监测持续性非卧床腹膜透析（CAPD）患者透析处方依从性的新方法。
进行了一项描述性观察研究，在两周时间内监测交换行为。
患者从门诊透析中心招募。
从北卡罗来纳州温斯顿 - 塞勒姆的皮埃蒙特透析中心接受CAPD治疗的患者中选取便利样本进行研究。31名CAPD患者中，20名（64.5%）同意参与。
使用每日日志和电子监测设备（药物事件监测系统，即MEMS；美国加利福尼亚州门洛帕克的APREX公司）监测CAPD患者对透析处方的依从性。患者在日志中记录两周观察期内的交换活动。同时，患者被指示在每次交换后立即将透析液袋的拉环放入MEMS瓶中。MEMS瓶用带有计算机芯片的瓶盖封闭，该芯片记录每次瓶子打开的日期和时间。
一名患者的MEMS设备出现故障，因此本报告中的数据基于其余19名患者。日志数据和MEMS数据之间存在显著差异，MEMS数据显示错过交换的次数和百分比更高。MEMS数据表明，一些患者在白天集中进行交换活动，交换之间的驻留时间缩短。本研究开发了三个指标：一个衡量不依从平均时间的指标，以及日内和日间交换时间一致性的指标。被定义为一致的患者与被定义为不一致的患者相比，不依从指数得分更低（p = 0.015）。
本研究描述了一种可能有助于评估腹膜透析方案依从性的方法。特别重要的是能够评估一天中交换的时间。由于数据可靠性和有效性问题、研究的短期性质、样本量小以及该方法学研究未考虑临床结果，临床意义有限。需要进一步研究以进一步开发这种数据收集方法。
