Hsieh Wen Ling, Yeh Shin Ting, Liu Wen I, Li I Hsien, Lee Shih Kai, Chien Wai Tong
School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
Patient Prefer Adherence. 2022 Apr 13;16:1017-1026. doi: 10.2147/PPA.S351848. eCollection 2022.
Increased medication adherence improves patient outcomes and lowers the overall cost of care by preventing disease relapse and hospital readmission. Several systematic reviews have identified that insight, therapeutic alliance, and attitude towards medication affect medication adherence in patients with schizophrenia; however, no study has examined all the aforementioned variables together nor has discussed the chains of these mediators.
To examine the insight-medication adherence relationship among community-dwelling schizophrenia patients through a serial multiple mediation model of therapeutic alliance and medication attitude.
This study with a cross-sectional correlational design included a convenience sample of community-dwelling schizophrenia patients from Taiwan (n = 229). From January 2017 to January 2018, data were collected by trained nurses using questionnaires. The PROCESS tool was used to analyse fine-grained chains.
In serial multiple mediation, the indirect effect of insight on medication adherence through therapeutic alliance and, subsequently, alteration of medication attitude was significant. However, the direct effect changed from significant to non-significant, indicating a complete mediating effect.
In community-dwelling schizophrenia patients, the effects of therapeutic alliance and medication attitude on medication adherence are greater than that of insight. We recommend revising the strategy of community home visits by different psychiatrists or nurses in alternating shifts. Therapeutic alliance is the first step required to promote medication adherence. Based on this alliance, altering the patients' medication attitude may be more effective in improving medication adherence than merely enhancing insight.
提高药物依从性可改善患者预后，并通过预防疾病复发和住院再入院降低总体护理成本。多项系统评价已确定，领悟、治疗联盟和对药物的态度会影响精神分裂症患者的药物依从性；然而，尚无研究同时考察上述所有变量，也未探讨这些中介因素之间的链式关系。
通过治疗联盟和药物态度的系列多重中介模型，研究社区居住的精神分裂症患者领悟与药物依从性之间的关系。
本研究采用横断面相关性设计，纳入了来自台湾的社区居住精神分裂症患者便利样本（n = 229）。2017年1月至2018年1月期间，由经过培训的护士使用问卷收集数据。采用PROCESS工具分析细粒度链式关系。
在系列多重中介中，领悟通过治疗联盟进而改变药物态度对药物依从性产生的间接效应显著。然而，直接效应从显著变为不显著，表明存在完全中介效应。
在社区居住的精神分裂症患者中，治疗联盟和药物态度对药物依从性的影响大于领悟。我们建议调整不同精神科医生或护士交替轮班进行社区家访的策略。治疗联盟是促进药物依从性所需的第一步。基于这种联盟，改变患者的药物态度可能比单纯增强领悟在提高药物依从性方面更有效。
