Morisky D E, Green L W, Levine D M
Med Care. 1986 Jan;24(1):67-74. doi: 10.1097/00005650-198601000-00007.
Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
与其他采用药物治疗和生活方式改变的疾病一样，坚持医疗方案仍然是原发性高血压患者管理中的一个主要临床问题。本文回顾了一种结构化的四项自我报告依从性测量方法（α信度=0.61）的心理测量特性，并测试了其同时效度和预测效度，该方法可轻松纳入就诊过程。量表中的项目涉及服药的障碍，并使医疗保健提供者能够强化积极的依从行为。在一个为期18个月的正规教育项目结束时收集了患者坚持医疗方案的数据。在3年的随访期内记录血压测量值。结果显示，该量表在2年和5年时分别在血压控制方面表现出同时效度和预测效度。在第2年四项量表得分高的患者中，75%在第5年血压得到充分控制，而得分低的患者在第5年血压得到控制的比例为47%（P<0.01）。
