McCann D P, Blossom H J
Department of Family and Community Medicine, Valley Medical Center, Fresno, CA 93702.
West J Med. 1990 Jul;153(1):44-9.
Patient nonadherence to therapeutic regimens is a serious issue in the practice of medicine. Empiric studies done by professionals from diverse backgrounds have shown that physicians who use educational strategies can be effective in gaining the cooperation of patients to follow their recommendations. The educational model that currently is most familiar to physicians and the one they use most frequently when educating patients is pedagogy, the theoretic basis for teaching children. Andragogy, a theoretic basis for teaching adults, is now being suggested by medical educators as an alternative model. To illustrate the clinical relevance and application of the andragogic approach, studies focusing on physician behaviors associated with behavioral measures of adherence were reviewed, analyzed, and categorized according to a framework called the "ADULT" model. Physicians in a postgraduate training program who have had exposure to this framework and have incorporated it into their practices report less difficulty functioning as patient educators. The systematic use of this approach can have a positive effect on patient adherence.
患者不遵守治疗方案是医学实践中的一个严重问题。来自不同背景的专业人员进行的实证研究表明，采用教育策略的医生在促使患者配合遵循其建议方面可能会取得成效。目前医生最熟悉且在对患者进行教育时最常使用的教育模式是教学法，即教导儿童的理论基础。而针对成人教学的理论基础——成人教育学，现正被医学教育工作者提议作为一种替代模式。为了阐明成人教育学方法的临床相关性及应用，对聚焦于与依从性的行为指标相关的医生行为的研究进行了回顾、分析，并根据一个名为“成人”模型的框架进行了分类。参加过研究生培训项目且接触过该框架并将其融入实践的医生报告称，在充当患者教育者时遇到的困难较少。系统地运用这种方法会对患者的依从性产生积极影响。
