Johnson Sara S, Driskell Mary-Margaret, Johnson Janet L, Dyment Sharon J, Prochaska James O, Prochaska Janice M, Bourne Leslie
Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island, USA.
Dis Manag. 2006 Apr;9(2):102-14. doi: 10.1089/dis.2006.9.102.
An estimated 60% of individuals prescribed lipid-lowering medications are nonadherent. Failure to adhere increases morbidity, mortality, healthcare utilization, and healthcare costs. This study examined the effectiveness of a population-based, individualized Transtheoretical Model (TTM) expert system intervention to improve adherence and increase exercise and diet in a randomized 18-month trial involving 404 adults. Compared to usual care, treatment participants who started in a pre-action stage were significantly more likely to be in the Action and Maintenance (A/M) stages for adherence at end of treatment (55.3% versus 40%, z = 2.11, p < 0.05, h = 0.31) and at 18-months (56% versus 37.8%, z = 2.38, p < 0.01, h = 0.36). The treatment group scored significantly better on two measures of adherence at six and 12 months post-treatment (all p < 0.05, odds ratios [OR] 1.49-3.67). Among those who began in A/M, treatment participants were significantly more likely to remain in A/M at 18 months (85.2% versus 55.6%, z = 2.63, p < 0.01, h = 0.67). Those receiving treatment were significantly more likely to progress to A/M for exercise and dietary fat reduction (43.3% versus 24.7% for exercise, and 24.7% versus 12.5% for diet). TTM expert system interventions can have a significant impact on entire populations for adherence. Results for dietary fat and exercise suggest covariation of treatment effects.
据估计，在服用降脂药物的人群中，有60%的人不遵医嘱。不遵医嘱会增加发病率、死亡率、医疗保健利用率和医疗成本。本研究在一项为期18个月的随机试验中，对404名成年人进行了基于人群的个体化跨理论模型（TTM）专家系统干预，以提高依从性，并增加运动和改善饮食。与常规护理相比，处于行动前阶段开始治疗的参与者在治疗结束时（55.3%对40%，z = 2.11，p < 0.05，h = 0.31）以及在18个月时（56%对37.8%，z = 2.38，p < 0.01，h = 0.36），处于行动和维持（A/M）阶段以坚持治疗的可能性显著更高。治疗组在治疗后6个月和12个月的两项依从性指标上得分显著更高（所有p < 0.05，优势比[OR]为1.49 - 3.67）。在那些从A/M阶段开始的人中，接受治疗的参与者在18个月时更有可能保持在A/M阶段（85.2%对55.6%，z = 2.63，p < 0.01，h = 0.67）。接受治疗的人在运动和减少膳食脂肪方面进展到A/M阶段的可能性显著更高（运动方面为43.3%对24.7%，饮食方面为24.7%对12.5%）。TTM专家系统干预对整个人群的依从性可能有重大影响。膳食脂肪和运动的结果表明治疗效果存在协变关系。
