Swain M A, Steckel S B
Res Nurs Health. 1981 Mar;4(1):213-22. doi: 10.1002/nur.4770040107.
In the treatment of hypertension, problems of nonadherence and consequent poor blood pressure control are particularly severe. Alternative intervention strategies were compared to explore means of improving adherence and lowering blood pressures. In a 3 x 4 repeated measures analysis of variance design, 115 patients were randomly selected and randomly assigned to one of three treatment modalities (routine clinic care, patient education, and contingency contracting) and were followed over four clinic visits. Subjects' knowledge about hypertension and its management, adherence to requests for regular medical follow-up, and blood pressure levels were measured. Patient education was not effective in lowering blood pressures; it produced an untoward outcome, a dropout rate higher than that for patients receiving only routine clinic care. However, contingency contracting was an effective intervention strategy for improving patient knowledge, F (1,59) = 51.32, p less than .0001; adherence to requests for regular medical care, Max L (2) = 25.9, p less than .0001; and decreasing diastolic blood pressures, F (2,49) = 3.39, p less than .05.
在高血压治疗中，不依从性问题以及随之而来的血压控制不佳情况尤为严重。对替代干预策略进行了比较，以探索提高依从性和降低血压的方法。在一项3×4重复测量方差分析设计中，随机选取了115名患者，并将他们随机分配到三种治疗方式之一（常规门诊护理、患者教育和应急契约），并在四次门诊就诊期间进行跟踪。测量了受试者关于高血压及其管理的知识、对定期医疗随访要求的依从性以及血压水平。患者教育在降低血压方面无效；它产生了一个不良结果，即辍学率高于仅接受常规门诊护理的患者。然而，应急契约是一种有效的干预策略，可提高患者知识，F(1,59)=51.32，p<0.0001；提高对定期医疗护理要求的依从性，Max L(2)=25.9，p<0.0001；并降低舒张压，F(2,49)=3.39，p<0.05。
