Lazaratou Helen, Anagnostopoulos Dimitris C, Vlassopoulos Maria, Tzavara Chara, Zelios George
Community Mental Health Center, University of Athens Faculty of Medicine, Department of Psychiatry, Athens, Greece.
Psychother Psychosom. 2006;75(2):113-21. doi: 10.1159/000090896.
Compliance in therapy appears to be linked to the process of therapeutic alliance. A positive patient-therapist relationship usually leads to successful completion of therapy. The aim of this study was to compare evidence, collected at two time periods in a Community Mental Health Center in Athens, on factors affecting treatment compliance. The hypothesis was that by modifying the therapeutic team's functioning, noncompliance could be reduced.
Epidemiological data were collected from child and adolescent out-patient files at two time periods: time period A, 1990-1994, n = 455 (sample A) and time period B, 2000-2002, n = 476 (sample B). Variables pertaining to the patient, his family and recommended treatment were examined. Student's t test and the Pearson chi2 test were used in order to explore the correlation of the variables with treatment completion in each sample. Logistic regression analyses were used to determine whether the effect of each variable on treatment completion differed between the two samples.
In sample A, most patients (58.6%) did not comply with therapy. The type of recommended treatment, the number of sessions, season of admission and the type of presented problem were found to correlate with treatment completion. Between the two time periods, certain modifications were implemented in the team's functioning (less diagnostic sessions, focused psychotherapy techniques, less time interval between referral and first diagnostic appointment). A significant reduction in the early termination rate (45.7%) was noted in sample B. The type of recommended treatment, the number of sessions, the family's situation, the mother's educational level and the patient's gender were related to treatment completion in sample B. The effect of the type of proposed treatment and the mean number of sessions of the completed treatments differed significantly between the two samples.
Early termination rates in therapy decreased between two time periods. This decrease may be attributed to modifications in the team's functioning, aimed at improving the therapeutic relationship. The limitation of this study is that only those factors pertaining to the service's organization and functioning were investigated.
治疗依从性似乎与治疗联盟过程相关。积极的医患关系通常会导致治疗的成功完成。本研究的目的是比较在雅典一家社区心理健康中心两个时间段收集的关于影响治疗依从性因素的证据。假设是通过改变治疗团队的运作方式，可以降低不依从性。
在两个时间段从儿童和青少年门诊档案中收集流行病学数据：A时间段，1990 - 1994年，n = 455（样本A）；B时间段，2000 - 2002年，n = 476（样本B）。检查了与患者、其家庭及推荐治疗相关的变量。使用学生t检验和Pearson卡方检验来探索每个样本中变量与治疗完成情况的相关性。使用逻辑回归分析来确定两个样本中每个变量对治疗完成情况的影响是否不同。
在样本A中，大多数患者（58.6%）不依从治疗。发现推荐治疗的类型、疗程数、入院季节和所呈现问题的类型与治疗完成情况相关。在两个时间段之间，团队运作方式进行了某些改变（减少诊断疗程、采用聚焦心理治疗技术、缩短转诊与首次诊断预约之间的时间间隔）。样本B中早期终止率显著降低（45.7%）。推荐治疗的类型、疗程数、家庭状况、母亲的教育水平和患者的性别与样本B中的治疗完成情况相关。两个样本中提议治疗类型和完成治疗的平均疗程数的影响存在显著差异。
两个时间段之间治疗的早期终止率有所下降。这种下降可能归因于团队运作方式的改变，旨在改善治疗关系。本研究的局限性在于仅调查了与服务组织和运作相关的那些因素。
