Department of Pharmacy Practice, School of Pharmacy, Northeastern University, 206 Mugar Life Sciences Building, 360 Huntington Avenue, Boston, MA 02115, USA.
Res Social Adm Pharm. 2010 Mar;6(1):49-62. doi: 10.1016/j.sapharm.2009.02.006. Epub 2009 Aug 3.
There has been relatively little theoretical research exploring the cognitive complexity of how patients decide the level to which they adhere to prescribed regimens.
To integrate various psychosocial theories into a conceptual framework to review how patients relate their medication use behavior to therapeutic outcomes and how such relationships affect subsequent medication use.
Key psychosocial theories were reviewed involving health beliefs and medication adherence, individual control, and how individuals might compare outcomes with expectations and alternatives. These concepts were integrated into one larger multilevel explanatory model, the Dynamic Exchange Model for Medication Adherence Levels and Comparison of Outcomes (DEMMALCO), explaining how patients might attribute outcomes related to their medication use and choose future actions based on expectations and alternatives available. Key assumptions of the model were also identified.
DEMMALCO indicates that patients make initial attributions of their control over their illness, which affects their subsequent adherence to their regimens. The model suggests that patients actively compare their treatment outcomes with their expectations about outcomes and the outcomes that are related to their best alternative. They are thought to reassess how their control in treatment was related to those outcomes and subsequently modify their adherence behavior based on the presence or absence of resources.
Strengths and limitations of the model are noted. DEMMALCO may help inform researchers and clinicians on new ways to conceptualize, monitor, and change medication adherence behavior.
对于患者如何决定其遵守规定治疗方案的程度的认知复杂性，相关理论研究相对较少。
将各种心理社会理论整合到一个概念框架中，以回顾患者如何将其用药行为与治疗结果联系起来，以及这些关系如何影响随后的用药行为。
回顾了关键的心理社会理论，涉及健康信念和药物依从性、个体控制以及个体如何将结果与期望和替代方案进行比较。这些概念被整合到一个更大的多层次解释模型中，即药物依从水平和结果比较的动态交换模型（DEMMALCO），解释了患者如何归因于与用药相关的结果，并基于可用的期望和替代方案选择未来的行动。该模型的关键假设也被确定。
DEMMALCO 表明，患者最初会对自己控制疾病的能力进行归因，这会影响他们随后对治疗方案的依从性。该模型表明，患者会主动将他们的治疗结果与他们对结果的期望以及与他们最佳替代方案相关的结果进行比较。他们被认为会重新评估他们在治疗中的控制与这些结果的关系，并根据资源的存在与否，随后调整他们的依从行为。
对模型的优缺点进行了说明。DEMMALCO 可能有助于研究人员和临床医生以新的方式概念化、监测和改变药物依从行为。
