Richardson M A, Simons-Morton B, Annegers J F
Center for Health Promotion Research, School of Public Health, University of Texas Houston Health Science Center, Houston 77225.
Health Educ Q. 1993 Winter;20(4):489-503. doi: 10.1177/109019819302000409.
Noncompliance with antihypertensive medication remains an obstacle to the management of hypertension, and despite research efforts over the past decade, the predictors of noncompliance remain unclear. According to values expectancy theory, individuals rationally choose noncompliance when the barriers or costs of treatment outweigh the expected benefits. Noncompliance, therefore, is likely to occur when net costs of treatment are high. Using a cross-sectional study design among subjects (n = 197) attending a specialized clinic for hypertension, we measured "net barriers" (costs), self-reported compliance, and possible determinants of noncompliance, including socio-demographics, the medical regimen, and locus of control. The effect of each quartile of the net barriers score (none, low, moderate, and high) on compliance, controlling for potential effect modifiers, was assessed using logistic regression modeling. Noncompliance (47%) was associated with younger age, higher salt use, longer duration of treatment, and higher levels of net barriers, but duration of treatment modified the effect of net barriers. Among subjects in short-term treatment, noncompliance increased with severity of net barriers suggesting a dose-response effect. In contrast, patients in long-term treatment showed no dose-response effect but a consistent association between noncompliance and levels of net barriers. Subjects at greater risk for noncompliance, however, were those who reported high net barriers, regardless of duration of treatment. Net barriers accounted for 50% of the noncompliance and appeared most important for patients who were younger or in the early stages of treatment. Implications for health care providers are discussed.
不遵医嘱服用降压药物仍然是高血压治疗的一个障碍，尽管在过去十年中进行了研究，但不遵医嘱的预测因素仍不明确。根据价值期望理论，当治疗的障碍或成本超过预期收益时，个体就会理性地选择不遵医嘱。因此，当治疗的净成本很高时，不遵医嘱的情况很可能发生。我们采用横断面研究设计，对197名前往高血压专科诊所就诊的受试者进行了研究，测量了“净障碍”（成本）、自我报告的依从性以及不遵医嘱的可能决定因素，包括社会人口统计学、治疗方案和控制点。使用逻辑回归模型评估净障碍评分的每个四分位数（无、低、中、高）对依从性的影响，并对潜在的效应修饰因素进行控制。不遵医嘱（47%）与年龄较小、盐摄入量较高、治疗时间较长以及净障碍水平较高有关，但治疗时间改变了净障碍的影响。在短期治疗的受试者中，不遵医嘱的情况随着净障碍的严重程度增加而增加，表明存在剂量反应效应。相比之下，长期治疗的患者没有显示出剂量反应效应，但不遵医嘱与净障碍水平之间存在一致的关联。然而，不遵医嘱风险较高的受试者是那些报告净障碍较高的人，无论治疗时间长短。净障碍占不遵医嘱情况的50%，对年龄较小或处于治疗早期的患者似乎最为重要。本文还讨论了对医疗保健提供者的启示。
