Kimmel P L, Peterson R A, Weihs K L, Simmens S J, Boyle D H, Verme D, Umana W O, Veis J H, Alleyne S, Cruz I
Department of Medicine, George Washington University Medical Center, Washington, D.C. 20037, USA.
J Am Soc Nephrol. 1995 Apr;5(10):1826-34. doi: 10.1681/ASN.V5101826.
The relationship between compliance and outcome is poorly understood, partially because there has been no gold standard for measuring compliance in hemodialysis patients. To investigate interrelationships between psychological, medical, and compliance factors, hemodialysis (HD) patients were studied with the Beck Depression Inventory, and a subset, the Cognitive Depression Index, the Perception of Illness Effects scale, and the Multidimensional Scale of Perceived Social Support. Behavioral compliance was measured in three ways: (1) percent time compliance (signifying "shortening behavior"); (2) percent attendance (signifying "skipping behavior) (3) percent total time compliance, assessing patients' time on dialysis normalized for prescribed time, including all shortenings and absences. Standard compliance indicators (predialysis serum potassium and phosphorus concentrations and interdialytic weight gain) were also analyzed. The patients' mean Beck Depression Inventory was in the range of mild depression. The prevalence of depression was 25.5%. Both depression indices correlated with Perception of Illness Effects scale scores. In general, social support was related to both measures of depression and perception of illness effects. Total time compliance was 95.8 +/- 5.0%. Younger patients were more likely to skip treatments compared with older patients. Time compliance comprised a wide spectrum, with most patients relatively compliant, whereas a small proportion received far less than their prescribed dialysis. Skipping and shortening behaviors did not correlate, suggesting that these constitute two separate types of noncompliant behaviors. Time compliance parameters did not correlate with potassium levels or interdialytic weight gain, but did correlate with phosphorus levels. Interrelationships between behavioral compliance measures and other parameters varied between units and patients of different gender. Finally, behavioral compliance patterns were stable over months in patients.(ABSTRACT TRUNCATED AT 250 WORDS)
依从性与治疗结果之间的关系尚未得到充分理解，部分原因是目前尚无衡量血液透析患者依从性的金标准。为了研究心理、医学和依从性因素之间的相互关系，我们使用贝克抑郁量表对血液透析（HD）患者进行了研究，并对其中一部分患者使用了认知抑郁指数、疾病影响感知量表和多维感知社会支持量表。行为依从性通过三种方式进行测量：（1）时间依从百分比（表示“缩短行为”）；（2）出勤百分比（表示“跳过行为”）；（3）总时间依从百分比，评估患者透析时间相对于规定时间的标准化情况，包括所有缩短和缺勤情况。还分析了标准依从性指标（透析前血清钾和磷浓度以及透析间期体重增加）。患者的平均贝克抑郁量表得分处于轻度抑郁范围内。抑郁症的患病率为25.5%。两个抑郁指数均与疾病影响感知量表得分相关。总体而言，社会支持与抑郁测量和疾病影响感知均相关。总时间依从率为95.8 +/- 5.0%。与老年患者相比，年轻患者更有可能跳过治疗。时间依从性范围较广，大多数患者相对依从，而一小部分患者接受的透析远少于规定量。跳过和缩短行为不相关，表明这是两种不同类型的不依从行为。时间依从性参数与钾水平或透析间期体重增加无关，但与磷水平相关。行为依从性测量与其他参数之间的相互关系在不同单位和不同性别的患者之间有所不同。最后，患者的行为依从模式在数月内保持稳定。（摘要截断于250字）
