Rudd P, Ahmed S, Zachary V, Barton C, Bonduelle D
Division of General Internal Medicine, Stanford University Medical Center, Calif. 94305-5475.
Cardiology. 1992;80 Suppl 1:2-10. doi: 10.1159/000175041.
Distinguishing among biological, pharmacological, and behavioural variability is essential for proper interpretation of the therapeutic experiment at each return visit. Within the behavioural component, partial compliance refers to all suboptimal levels of concordance between the patient's behaviour and the clinical prescription. However, the assessment of compliance is limited largely by imperfect measures of medication taking which are frequently distant in time and space from the medication-taking event itself. Most studies indicate compliance levels of only 50-70% with antihypertensive regimens as well as considerable variance from day to day and person to person. Therapeutic outcome may be a misleading method to assess the sufficiency of a regimen because of the high prevalence of suboptimal medication-taking behaviour. In selected situations, prolongation of pharmacological effect may compensate for imperfect medication-taking behaviour, confirmed by electronic medication monitors. Such pharmacodynamic prolongation exemplifies therapeutic sufficiency, a new paradigm for therapeutics in the 1990s.
区分生物学、药理学和行为学方面的变异性，对于每次复诊时正确解读治疗实验至关重要。在行为学因素中，部分依从性是指患者行为与临床处方之间所有未达最佳水平的一致性。然而，依从性评估在很大程度上受到服药情况测量不完善的限制，这些测量往往在时间和空间上与服药事件本身相隔甚远。大多数研究表明，抗高血压治疗方案的依从性仅为50%至70%，而且每天和人与人之间存在相当大的差异。由于次优服药行为的高发生率，治疗结果可能是评估治疗方案充分性的一种误导方法。在特定情况下，药理作用的延长可能会弥补不完善的服药行为，电子药物监测器已证实了这一点。这种药效学延长体现了治疗充分性，这是20世纪90年代治疗学的一种新范式。
