Ogedegbe Gbenga, Schoenthaler Antoinette, Richardson Tabia, Lewis Lisa, Belue Rhonda, Espinosa Eugenia, Spencer Jacqueline, Allegrante John P, Charlson Mary E
Columbia University Medical Center, United States.
Contemp Clin Trials. 2007 Feb;28(2):169-81. doi: 10.1016/j.cct.2006.04.002. Epub 2006 May 12.
Hypertension disproportionately affects African Americans compared to whites, and it is the single most common explanation for the disparity in mortality between African Americans and whites. Adherence with antihypertensive medications can help reduce risk of negative hypertension-related outcomes. Motivational interviewing is a promising patient-centered approach for improving adherence in patients with chronic diseases. In this paper we describe the rationale and design of an ongoing randomized controlled trial testing the effectiveness of motivational interviewing versus usual care in improving medication adherence among 190 African American uncontrolled hypertensive patients, who receive care in a primary care setting.
The usual care group receives standard medical care, while those in the intervention group receive standard care plus four sessions of motivational interviewing at 3-month intervals for a period of 1 year. This technique consists of brief, patient-driven counseling sessions to facilitate initiation and maintenance of behavior change. The primary outcome is adherence to prescribed antihypertensive medication, assessed with the electronic medication events monitoring system (MEMS) and the Morisky self-report adherence questionnaire. Secondary outcomes are within-patient changes in blood pressure, self-efficacy, and intrinsic motivation between baseline and 12 months. We report the baseline sociodemographic and clinical characteristics of the participants.
Despite the potential utility of motivational interviewing, little is known about its effectiveness in improving medication adherence among hypertensive patients, especially African Americans. In addition to the baseline data this study has generated, this trial should provide data with which we can assess the effectiveness of this approach as a behavioral intervention.
与白人相比，高血压对非裔美国人的影响尤为严重，这是导致非裔美国人和白人死亡率差异的最常见单一原因。坚持服用抗高血压药物有助于降低高血压相关不良后果的风险。动机性访谈是一种很有前景的以患者为中心的方法，可提高慢性病患者的依从性。在本文中，我们描述了一项正在进行的随机对照试验的基本原理和设计，该试验旨在测试动机性访谈与常规护理相比，在改善190名在初级保健机构接受治疗的未控制高血压的非裔美国患者的药物依从性方面的有效性。
常规护理组接受标准医疗护理，而干预组在1年的时间里每隔3个月接受标准护理加4次动机性访谈。该技术包括简短的、由患者主导的咨询会议，以促进行为改变的启动和维持。主要结局是对规定的抗高血压药物的依从性，通过电子药物事件监测系统（MEMS）和Morisky自我报告依从性问卷进行评估。次要结局是患者在基线和12个月之间血压、自我效能和内在动机的自身变化。我们报告了参与者的基线社会人口统计学和临床特征。
尽管动机性访谈具有潜在效用，但对于其在改善高血压患者尤其是非裔美国人的药物依从性方面的有效性知之甚少。除了本研究产生的基线数据外，该试验应提供数据，以便我们能够评估这种方法作为一种行为干预的有效性。
