Moral Roger Ruiz, Torres Luis Angel Pérula de, Ortega Laura Pulido, Larumbe Margarita Criado, Villalobos Ana Roldán, García Jose Angel Fernández, Rejano Juan Manuel Parras
Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain.
Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
Patient Educ Couns. 2015 Aug;98(8):977-83. doi: 10.1016/j.pec.2015.03.008. Epub 2015 Mar 18.
To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy.
Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG).
MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an "advice approach". Three follow-up visits were completed, at 15 days and at 3 and 6 months. Medication adherence in both groups was compared (p<0.05).
Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93).
A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice.
MI is a patient-centered approach that can be used to improve medication adherence in primary care.
This trial is registered at ClinicalTrials.gov (NCT01291966).
评估动机性访谈（MI）对改善接受多种药物治疗的老年患者用药依从性的有效性。
在16个初级保健中心进行整群随机临床试验，涉及27名医疗服务提供者和154名患者。32名医疗服务提供者被分配到试验组（EG）或对照组（CG）。
MI培训项目及患者治疗回顾。试验组的医疗服务提供者进行MI，而对照组的提供者采用“建议法”。在15天、3个月和6个月时完成三次随访。比较两组的用药依从性（p<0.05）。
招募患者：70/84（试验组/对照组）。平均年龄：76岁；女性：68.8%。试验组中转变为依从性的受试者比例高7.6%（p<0.001）。试验组患者、女性患者（OR=0.24）和高学历患者（OR=3.93）的治疗依从性更高。
在初级保健中采用面对面的动机性方法，有助于接受多种药物治疗的老年慢性病患者比传统的提供信息和建议策略达到更高的治疗依从水平。
MI是以患者为中心的方法，可用于改善初级保健中的用药依从性。
本试验已在ClinicalTrials.gov注册（NCT01291966）。
