Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center.
Department of Psychology and Neuroscience, Duke University.
Am Psychol. 2018 Nov;73(8):968-980. doi: 10.1037/amp0000316.
Poor adherence to cardiovascular disease medications carries significant psychological, physical, and economic costs, including failure to achieve therapeutic goals, high rates of hospitalization and health care costs, and incidence of death. Despite much effort to design and evaluate adherence interventions, rates of adherence to cardiovascular-related medications have remained relatively stagnant. We identify two major reasons for this: First, interventions have not addressed the time-varying reasons for nonadherence, and 2nd, interventions have not explicitly targeted the self-regulatory processes involved in adherence behavior. Inclusion of basic and applied psychological science in intervention development may improve the efficacy and effectiveness of behavioral interventions to improve adherence. In this article, we use a taxonomy of time-based phases of adherence-including initiation, implementation, and discontinuation-as context within which to review illustrative studies of barriers to adherence, interventions to improve adherence, and self-regulatory processes involved in adherence. Finally, we suggest a framework to translate basic psychological science regarding self-regulation into multicomponent interventions that can address multiple and time-varying barriers to nonadherence across the three adherence phases. The field of psychology is essential to improving medication adherence and associated health outcomes, and concrete steps need to be taken to implement this knowledge in future interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
心血管疾病药物治疗依从性差会带来重大的心理、生理和经济成本，包括无法达到治疗目标、高住院率和医疗保健费用以及死亡率上升。尽管在设计和评估依从性干预措施方面付出了很多努力，但心血管相关药物的依从率仍然相对停滞不前。我们发现了造成这种情况的两个主要原因：第一，干预措施没有解决非依从性的时变原因，第二，干预措施没有明确针对依从行为所涉及的自我调节过程。将基础和应用心理学科学纳入干预措施的发展中，可能会提高改善依从性的行为干预措施的效果和效率。在本文中，我们使用依从性的基于时间的阶段分类（包括开始、实施和停止）作为背景，回顾了关于依从性障碍、改善依从性的干预措施以及依从性所涉及的自我调节过程的说明性研究。最后，我们提出了一个框架，将关于自我调节的基础心理学科学转化为多成分干预措施，可以解决三个依从阶段中多种和时变的不依从障碍。心理学领域对于改善药物依从性和相关健康结果至关重要，需要采取具体措施将这方面的知识应用于未来的干预措施中。
