Holzemer William L, Bakken Suzanne, Portillo Carmen J, Grimes Richard, Welch Jennifer, Wantland Dean, Mullan Joseph T
Department of Community Health Systems, School of Nursing, University of California, San Francisco, 94143, USA.
Nurs Res. 2006 May-Jun;55(3):189-97. doi: 10.1097/00006199-200605000-00005.
The relationship between patient adherence and treatment outcomes has been documented across chronic health conditions, but the evidence base for effective adherence interventions in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) requires more rigorous research and reporting.
The aims of this study were to determine whether a tailored, nurse-delivered adherence intervention program--Client Adherence Profiling and Intervention Tailoring (CAP-IT)--improved adherence to HIV medications, compared with standard care, and to identify the relationship among adherence measures.
A randomized controlled trial (RCT) with repeated measures was used to test the efficacy of CAP-IT over a 6-month period. A convenience sample of 240 participants was recruited from a freestanding public HIV/AIDS clinic in Houston, TX, that provides medical, psychological, and pharmaceutical services for over 5,000 clients. Study instruments and measures included demographics; chart audit to capture CD4 count, viral load, and prescribed medications; health literacy; and five measures of adherence (AIDS Clinical Trial Group-Revised Reasons for Missing Medications, Morisky Self-Report of Medication Non-Adherence, Pill Count, Medication Event Monitoring System [MEMS] caps, and Pharmacy Refill).
A logistic regression using generalized estimating equations method showed no significant differences over time on the five medication-adherence measures between the experimental and control groups. Little correlation was documented among the five different adherence measures, and there was minimal correlation with clinical markers.
It is unclear why the tailored adherence intervention was not efficacious in improving medication adherence. The findings suggest that these measures of medication adherence did not perform as expected and that, perhaps, they are not adequate measures of adherence. Effective and efficient adherence interventions are needed to address the barriers to medication adherence in HIV/AIDS.
患者依从性与治疗结果之间的关系在各种慢性健康状况中均有记录，但针对人类免疫缺陷病毒（HIV）和获得性免疫缺陷综合征（AIDS）有效依从性干预措施的证据基础需要更严格的研究和报告。
本研究的目的是确定一种量身定制的、由护士提供的依从性干预项目——患者依从性剖析与干预定制（CAP-IT）——与标准护理相比，是否能提高对HIV药物的依从性，并确定依从性测量指标之间的关系。
采用重复测量的随机对照试验（RCT），在6个月的时间内测试CAP-IT的疗效。从德克萨斯州休斯顿一家独立的公共HIV/AIDS诊所招募了240名便利样本参与者，该诊所为5000多名患者提供医疗、心理和药物服务。研究工具和测量指标包括人口统计学信息；用于获取CD4细胞计数、病毒载量和处方药物的病历审核；健康素养；以及五种依从性测量指标（艾滋病临床试验组修订的漏服药物原因、Morisky药物不依从自我报告、药片计数、药物事件监测系统[MEMS]瓶盖和药房再填充）。
使用广义估计方程法进行的逻辑回归显示，随着时间的推移，实验组和对照组在五种药物依从性测量指标上没有显著差异。五种不同的依从性测量指标之间几乎没有相关性，与临床指标的相关性也很小。
尚不清楚为何量身定制的依从性干预在提高药物依从性方面无效。研究结果表明，这些药物依从性测量指标并未达到预期效果, 也许它们并不是足够的依从性测量指标。需要有效且高效的依从性干预措施来解决HIV/AIDS患者药物依从性的障碍。
