Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Sydney, Australia.
Behav Res Ther. 2012 Aug;50(7-8):463-8. doi: 10.1016/j.brat.2012.04.001. Epub 2012 Apr 24.
Since 2009, the Clinical Research Unit for Anxiety and Depression (CRUfAD) has been providing primary care clinicians with internet cognitive behaviour therapy (iCBT) courses to prescribe to patients. Although these courses have demonstrated efficacy in research trials, adherence in primary care is less than half that of the research trials. The present studies pose three questions: first, do course non-completers drop out because of lack of efficacy? Second, can changes in delivery (e.g. adding choice, reminders and financial cost) improve adherence? Last, does clinician contact improve adherence? The results showed that non-completers derive benefit before dropping out; that adding reminders, choice of course and timing, and financial cost can significantly improve adherence; and that clinician contact during the course is associated with increased adherence. It is concluded that improved adherence is an important determinant of effectiveness.
自 2009 年以来，焦虑和抑郁临床研究小组（CRUfAD）一直为初级保健临床医生提供互联网认知行为疗法（iCBT）课程，以便为患者开具处方。尽管这些课程在研究试验中已证明有效，但在初级保健中的依从性却不到研究试验的一半。本研究提出了三个问题：第一，课程未完成者是否因为疗效不佳而退出？第二，改变交付方式（例如增加选择、提醒和经济成本）能否提高依从性？最后，临床医生的联系是否能提高依从性？结果表明，未完成课程的患者在退出前已受益；添加提醒、课程选择和时间安排以及经济成本可以显著提高依从性；并且在课程期间与临床医生联系与增加依从性有关。研究得出结论，提高依从性是有效性的重要决定因素。
