Esmonde Nick O, Garfinkle Judah S, Chen Yiyi, Lambert William E, Kuang Anna A
1 Division of Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, OR, USA.
2 Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA.
Cleft Palate Craniofac J. 2018 Feb;55(2):252-258. doi: 10.1177/1055665617718550. Epub 2017 Dec 14.
Identify factors associated with adherence to nasoalveolar molding (NAM) therapy.
Retrospective case-control study.
Tertiary referral center.
PATIENTS, PARTICIPANTS: Infants with cleft lip, with or without cleft palate, referred for NAM. One hundred thirty-five patients met criteria.
MAIN OUTCOME MEASURE(S): Adherence to NAM therapy, defined as continuous use of the appliance and attendance of NAM adjustment visits.
Female sex (OR = 2.85, 95% CI 1.21-6.74), bilateral cleft (OR = 2.88, 95% CI 1.29-6.46), and travel distance (OR = 1.01, 95% CI 1.00-1.01) were independent predictors of nonadherence. Bilateral clefts (OR = 8.35, 95% CI 2.72-25.64) and public-payer insurance (OR = 3.67, 95% CI 1.13-11.91) for male patients were significantly associated with nonadherence, in our sex-stratified multivariate model. The majority of the families (58%) had public health insurance. Males comprised 77.0% of the cohort.
NAM treatment adherence is impaired by bilateral clefts, female sex, increased travel distance, and public insurance. Further studies are warranted to investigate how these factors affect adherence, and to develop interventions to improve adherence in families at risk due to economic or psychosocial barriers.
确定与鼻牙槽塑形（NAM）治疗依从性相关的因素。
回顾性病例对照研究。
三级转诊中心。
患者、参与者：因NAM前来就诊的唇裂婴儿，有或无腭裂。135名患者符合标准。
NAM治疗的依从性，定义为持续使用矫治器并按时参加NAM调整复诊。
女性（比值比[OR]=2.85，95%置信区间[CI]1.21 - 6.74）、双侧唇裂（OR = 2.88，95% CI 1.29 - 6.46）和出行距离（OR = 1.01，95% CI 1.00 - 1.01）是非依从性的独立预测因素。在我们按性别分层的多变量模型中，男性患者的双侧唇裂（OR = 8.35，95% CI 2.72 - 25.64）和公共支付者保险（OR = 3.67，95% CI 1.13 - 11.91）与非依从性显著相关。大多数家庭（58%）拥有公共医疗保险。男性占队列的77.0%。
双侧唇裂、女性、出行距离增加和公共保险会损害NAM治疗的依从性。有必要进一步研究这些因素如何影响依从性，并制定干预措施以提高因经济或心理社会障碍而处于风险中的家庭的依从性。
