Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa 52242, USA.
Pharmacotherapy. 2010 May;30(5):432-41. doi: 10.1592/phco.30.5.432.
To determine the relationship between poor adherence and self-efficacy or social support after a pharmacist intervention.
Post-hoc analysis of data from two randomized controlled trials of physician-pharmacist collaborative interventions (6 and 9 mo, respectively) to improve blood pressure control.
Eleven university-affiliated primary care clinics.
Five hundred eighty-four patients (aged 21-85 yrs) with uncontrolled primary hypertension; 296 were in the intervention group and 288 were in the control group.
Pharmacists provided intensified hypertension management and drug adherence counseling to patients in the intervention group.
Social support and self-efficacy questionnaires were administered at baseline and end-of-study visits. Patient adherence was monitored by using the Morisky self-reported adherence questionnaire. Self-reported adherence scores improved significantly in the control group (p=0.0053) but not in the intervention group; however, adherence at baseline in both groups was high. There were small, but significant, improvements in self-efficacy (p<0.04) and social support (p<0.05) scores in the intervention group but not the control group at the end of the study. Social support and, to a lesser extent, self-efficacy improved as a function of duration of study participation (9-mo vs 6-mo intervention), regardless of whether the patient received the intervention. Blood pressure control in both groups improved significantly at the end of the study; however, mean blood pressure was significantly lower in the intervention group (129.7/76.6 mm Hg) compared with the control group (140.8/78.9 mm Hg; p<0.0001 for systolic, p=0.032 for diastolic).
Social support and self-efficacy improved significantly in the intervention group at the end of the pharmacist intervention. Drug adherence was correlated with self-efficacy even though drug adherence did not improve significantly in the intervention group. The fact that social support and self-efficacy improved as a function of duration of study participation suggests that participation in a research study may have had a positive influence on these measures. Even though the changes in social support, self-efficacy, and drug adherence were modest, there was significantly better blood pressure control in the intervention group compared with the control group. These findings indicate that changes in drug adherence, self-efficacy, or social support probably played a minor role in the blood pressure outcomes in these studies.
确定药师干预后药物依从性差与自我效能或社会支持之间的关系。
对 2 项医师-药师合作干预措施（分别为 6 个月和 9 个月）改善血压控制的随机对照试验数据进行事后分析。
11 家大学附属初级保健诊所。
584 例年龄 21-85 岁的未控制原发性高血压患者；其中 296 例患者在干预组，288 例患者在对照组。
药师为干预组患者提供强化高血压管理和药物依从性咨询。
在基线和研究结束时进行社会支持和自我效能问卷评估。通过 Morisky 自我报告的药物依从性问卷监测患者的药物依从性。对照组的自我报告药物依从性评分显著提高（p=0.0053），但干预组无显著提高；然而，两组患者在基线时的药物依从性均较高。研究结束时，干预组的自我效能（p<0.04）和社会支持（p<0.05）评分略有但有统计学意义的提高，但对照组无显著提高。社会支持和自我效能均随研究参与时间（9 个月 vs 6 个月干预）的延长而改善，而与患者是否接受干预无关。两组患者的血压控制在研究结束时均显著改善；然而，干预组的平均血压（129.7/76.6mmHg）显著低于对照组（140.8/78.9mmHg；收缩压 p<0.0001，舒张压 p=0.032）。
在药师干预结束时，干预组的社会支持和自我效能显著提高。尽管干预组的药物依从性没有显著提高，但药物依从性与自我效能相关。社会支持和自我效能随研究参与时间延长而改善的事实表明，参与研究可能对这些措施产生积极影响。尽管社会支持、自我效能和药物依从性的变化幅度较小，但干预组的血压控制明显优于对照组。这些发现表明，药物依从性、自我效能或社会支持的变化在这些研究的血压结果中可能作用较小。
