Columbia University School of Social Work, New York, NY 10027, USA.
Harv Rev Psychiatry. 2011 Jul-Aug;19(4):177-89. doi: 10.3109/10673229.2011.602560.
Nonadherence is the Achilles' heel of effective psychiatric treatment. It affects the resolution of mental health symptoms and interferes with the assessment of treatment response. The meaning of the term adherence has evolved over time and is now associated with a variety of definitions and measurement methods. The result has been a poorly operationalized and nonstandardized term that is often interpreted differently by providers and patients. Drawing extensively from the literature, this article aims to (1) describe changes in the concept of adherence, drawing from the mental health treatment literature, (2) present a more comprehensive definition of adherence that recognizes the role of patient-provider transactions, (3) introduce dynamic adherence, a six-phase model, which incorporates the role of transactional processes and other factors that influence patients' adherence decisions, and (4) provide recommendations for providers to improve adherence as well as their relationships with patients.
不依从是有效精神科治疗的致命弱点。它会影响精神健康症状的缓解，并干扰对治疗反应的评估。这个术语的含义随着时间的推移而演变，现在与各种定义和测量方法相关联。其结果是一个操作性差且未标准化的术语，提供者和患者常常对其有不同的解释。本文广泛借鉴文献，旨在：(1)从心理健康治疗文献中描述依从性概念的变化；(2)提出一个更全面的依从性定义，认识到医患交易的作用；(3)引入动态依从性，即一个六阶段模型，其中纳入了交易过程和其他影响患者依从性决策的因素的作用；(4)为提供者提供改善依从性以及改善与患者关系的建议。
