DiMatteo M Robin, Haskard Kelly B, Williams Summer L
Department of Psychology, University of California, Riverside, California 92521, USA.
Med Care. 2007 Jun;45(6):521-8. doi: 10.1097/MLR.0b013e318032937e.
A large body of empirical data exists on the prediction of patient adherence from subjective and objective assessments of health status and disease severity. This work can be summarized with meta-analysis.
Retrieval and summary analysis of r effect sizes and moderators of the relationship between patient adherence and patients': (1) beliefs in disease threat; (2) rated health status (by physician, self, or parent); and (3) objective disease severity.
Comprehensive search of published literature (1948-2005) yielding 116 articles, with 143 separate effect sizes. Calculation of robust, generalizable random effects model statistics, and detailed examination of study diversity with moderator analyses.
Adherence is significantly positively correlated with patients' beliefs in the severity of the disease to be prevented or treated ("disease threat"). Better patient adherence is associated with objectively poorer health only for patients experiencing disease conditions lower in seriousness (according to the Seriousness of Illness Rating Scale). Among conditions higher in seriousness, worse adherence is associated with objectively poorer health. Similar patterns exist when health status is rated by patients themselves, and by parents in pediatric samples.
Results suggest that the objective severity of patients' disease conditions, and their awareness of this severity, can predict their adherence. Patients who are most severely ill with serious diseases may be at greatest risk for nonadherence to treatment. Findings can contribute to greater provider awareness of the potential for patient nonadherence, and to better targeting of health messages and treatment advice by providers.
关于通过对健康状况和疾病严重程度的主观及客观评估来预测患者依从性，已有大量实证数据。这项工作可用荟萃分析进行总结。
检索并汇总分析患者依从性与患者以下方面关系的效应量及调节因素：（1）对疾病威胁的信念；（2）（由医生、患者自身或家长评定的）健康状况评分；（3）客观疾病严重程度。
全面检索已发表文献（1948 - 2005年），得到116篇文章，包含143个独立效应量。计算稳健、可推广的随机效应模型统计量，并通过调节因素分析详细考察研究的多样性。
依从性与患者对要预防或治疗疾病的严重程度的信念（“疾病威胁”）显著正相关。仅对于病情严重程度较低（根据疾病严重程度评分量表）的患者，更好的患者依从性与客观上较差的健康状况相关。在病情严重程度较高的情况下，较差的依从性与客观上较差的健康状况相关。当由患者自身以及儿科样本中的家长对健康状况进行评定时，也存在类似模式。
结果表明，患者疾病状况的客观严重程度及其对这种严重程度的认知能够预测其依从性。患有严重疾病的重症患者可能最有不遵医嘱治疗的风险。这些发现有助于医护人员更清楚地认识到患者不依从的可能性，并更好地针对患者调整健康信息和治疗建议。
