Our Lady's Children's Hospital, Dublin, Ireland.
Eur Child Adolesc Psychiatry. 2012 Dec;21(12):657-63. doi: 10.1007/s00787-012-0304-7. Epub 2012 Sep 4.
Two factors predict treatment outcome, how effective the treatment is and whether the patient takes or follows the treatment plan. As clinicians or scientists, we strive to develop newer and more effective treatments, both pharmacological and non-pharmacological to improve treatment outcome in our patient population. Adherence is the single most modifiable factor associated with treatment outcome, yet how often is the issue of adherence addressed in clinical consultations? The best treatment is rendered useless if not adhered to. Initial adherence rates are low and get worse with time, but methodological difficulties in studies make it difficult to determine both the clinical implication of suboptimal adherence and successful strategies. Further research should apply more rigour to the area of definition and measurement, be sufficiently powered and long term, and measure possible confounders, to allow for an understanding on the link and impact between adherence and clinical outcome. This article reviews some of the main issues with regard to adherence and cost implications of suboptimal adherence and suggests future directions.
有两个因素可以预测治疗结果，一是治疗的有效性，二是患者是否接受或遵循治疗计划。作为临床医生或科学家，我们努力开发更新、更有效的治疗方法，包括药物和非药物治疗，以改善我们患者群体的治疗结果。依从性是与治疗结果最相关的可改变因素，但在临床咨询中，我们有多少次会关注依从性问题呢？如果不遵守治疗方案，即使是最好的治疗也会变得无效。初始依从率较低，随着时间的推移会变得更差，但研究中方法学上的困难使得确定不依从的临床意义和成功策略变得困难。进一步的研究应该更加严格地定义和测量该领域，要有足够的效力和长期随访，并测量可能的混杂因素，以了解依从性和临床结果之间的联系和影响。本文综述了一些关于依从性的主要问题，以及不依从的成本影响，并提出了未来的研究方向。
