Solomon Daniel H, Iversen Maura D, Avorn Jerry, Gleeson Timothy, Brookhart M Alan, Patrick Amanda R, Rekedal Laura, Shrank William H, Lii Joyce, Losina Elena, Katz Jeffrey N
Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
Arch Intern Med. 2012 Mar 26;172(6):477-83. doi: 10.1001/archinternmed.2011.1977. Epub 2012 Feb 27.
Multiple studies demonstrate poor adherence to medication regimens prescribed for chronic illnesses, including osteoporosis, but few interventions have been proven to enhance adherence. We examined the effectiveness of a telephone-based counseling program rooted in motivational interviewing to improve adherence to a medication regimen for osteoporosis.
We conducted a 1-year randomized controlled clinical trial. Participants were recruited from a large pharmacy benefits program for Medicare beneficiaries. All potentially eligible individuals had been newly prescribed a medication for osteoporosis. Consenting participants were randomized to a program of telephone-based counseling (n = 1046) using a motivational interviewing framework or a control group (n = 1041) that received mailed educational materials. Medication regimen adherence was the primary outcome compared across treatment arms and was measured as the median (interquartile range) medication possession ratio, calculated as the ratio of days with filled prescriptions to total days of follow-up.
The groups were balanced at baseline, with a mean age of 78 years; 93.8% were female. In an intention-to-treat analysis, median adherence was 49% (interquartile range, 7%-88%) in the intervention arm and 41% (2%-86%) in the control arm (P = .07, Kruskal-Wallis test). There were no differences in self-reported fractures.
In this randomized controlled trial, we did not find a statistically significant improvement in adherence to an osteoporosis medication regimen using a telephonic motivational interviewing intervention.
多项研究表明，包括骨质疏松症在内的慢性疾病患者对所开药物治疗方案的依从性较差，但很少有干预措施被证明能提高依从性。我们研究了一种基于电话咨询的项目的有效性，该项目以动机性访谈为基础，旨在提高对骨质疏松症药物治疗方案的依从性。
我们进行了一项为期1年的随机对照临床试验。参与者从一个针对医疗保险受益人的大型药房福利项目中招募。所有潜在符合条件的个体均新开具了骨质疏松症药物处方。同意参与的参与者被随机分为使用动机性访谈框架的电话咨询项目组（n = 1046）或接受邮寄教育材料的对照组（n = 1041）。比较各治疗组之间的药物治疗方案依从性作为主要结果，通过药物持有率中位数（四分位间距）来衡量，计算方法为有处方配药天数与总随访天数的比值。
两组在基线时均衡，平均年龄78岁；93.8%为女性。在意向性分析中，干预组的依从性中位数为49%（四分位间距，7%-88%），对照组为41%（2%-86%）（P = 0.07，Kruskal-Wallis检验）。自我报告的骨折情况无差异。
在这项随机对照试验中，我们未发现使用电话动机性访谈干预措施在骨质疏松症药物治疗方案的依从性方面有统计学上的显著改善。
