评估一种基于小组的行为干预措施，以促进炎症性肠病青少年的遵医行为。
Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease.
机构信息
Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
出版信息
Eur J Gastroenterol Hepatol. 2012 Jan;24(1):64-9. doi: 10.1097/MEG.0b013e32834d09f1.
OBJECTIVE
To pilot test the feasibility and acceptability of a family-based group behavioral intervention and to improve medication adherence in adolescents diagnosed with inflammatory bowel disease.
METHODS
Participants were 40 adolescents aged 11-18 years diagnosed with inflammatory bowel disease and their primary caregivers, who were randomized to either a four-session Family-Based Group Behavioral Treatment or Usual Care over a 6-week period. Adherence was measured using a multi-method, multi-informant assessment involving caregiver-report and patient-report, pill count data, and electronic monitoring.
RESULTS
Adherence rates ranged from 66 to 89% for 6-mercaptopurine/azathioprine and 51 to 93% for mesalamine across assessment methods. The intervention was feasible, as evidenced by the 99% treatment session attendance rate, and acceptable based on patient and caregiver report. Repeated measures analysis of variance tests revealed nonsignificant differences between the conditions from baseline to post-treatment assessments for pill count, electronic monitor, and primary caregiver-reported adherence (P's>0.05). There was a statistically significant improvement in patient-reported mesalamine adherence represented by a significant main effect for Condition (F=22.24, P<0.01; δ=0.79) and Condition×Time interaction (F=13.32, P<0.05; δ=0.69).
CONCLUSION
Findings suggest potential for use of behavioral intervention to improve medication adherence in this population. This intervention may be more effective with more complex regimens (e.g. multiple doses per day) such as those prescribed with mesalamine. Further research is needed to examine this type of intervention in more diverse samples with more active disease. Use of alternative adherence measurement approaches, including electronic pill boxes and/or real-time self-report (e.g. by text messaging, electronic diaries, etc.) is also recommended.
目的
检验基于家庭的团体行为干预的可行性和可接受性，并提高青少年炎症性肠病患者的药物依从性。
方法
40 名年龄在 11-18 岁之间被诊断为炎症性肠病的青少年及其主要照顾者参与了本研究，他们被随机分配到为期 6 周的基于家庭的团体行为治疗或常规护理。采用多方法、多信息源评估，包括照顾者报告和患者报告、药丸计数数据和电子监测来评估依从性。
结果
6-巯基嘌呤/硫唑嘌呤和柳氮磺胺吡啶的依从率在评估方法中分别为 66%至 89%和 51%至 93%。干预措施是可行的，这一点从 99%的治疗会议出席率就可以看出，而且根据患者和照顾者的报告，该措施是可以接受的。重复测量方差分析检验表明，在治疗前后的评估中，两种条件之间在药丸计数、电子监测和主要照顾者报告的依从性方面没有显著差异（P＞0.05）。患者报告的柳氮磺胺吡啶依从性有统计学上的显著改善，表现为条件的主要效应显著（F=22.24，P＜0.01；δ=0.79）和条件×时间的交互作用显著（F=13.32，P＜0.05；δ=0.69）。
结论
研究结果表明，行为干预有可能提高该人群的药物依从性。这种干预措施可能对更复杂的治疗方案（如每天多次服药）更有效，如柳氮磺胺吡啶的治疗方案。需要进一步研究在更多疾病活跃的、不同样本人群中进行这种干预的效果。还建议使用替代的依从性测量方法，包括电子药盒和/或实时自我报告（例如通过短信、电子日记等）。
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