Dew M A, Roth L H, Thompson M E, Kormos R L, Griffith B P
Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, PA 15213, USA.
J Heart Lung Transplant. 1996 Jun;15(6):631-45.
Although poor medical compliance is a major risk factor for morbidity and mortality after heart transplantation, no prospective data are available on rates of noncompliance with each component of the posttransplantation regimen. Little is known about the impact of health history, sociodemographic, or perioperative psychosocial variables on long-term compliance.
Compliance in eight domains was examined in a cohort of 101 heart recipients followed through the first year after transplantation. Patients received detailed interviews at 2, 7, and 12 months after transplantation. Additional corroborative information was obtained from family member interviews and nurse evaluations. Potential predictors of noncompliance were obtained from medical record reviews and from initial patient interviews. Predictors pertained to cardiac-related history, psychiatric history, sociodemographic variables, and perioperative psychosocial status (psychologic adaptation, social supports, coping strategies).
Although degree of noncompliance varied across timepoints, rates of persistent noncompliance during the year were as follows: 37% (exercise); 34% (monitoring blood pressure); 20% (medications); 19% (smoking); 18% (diet); 15% (having blood work completed); 9% (clinic attendance); and 6% (heavy drinking). Compliance in most areas worsened significantly (p < 0.05) over time. Background health-related and sociodemographic characteristics showed no significant influence on any area of posttransplantation compliance. Perioperative psychosocial characteristics were strong and significant predictors of noncompliance.
Pretransplantation screening for background and demographic variables may have limited utility for compliance outcomes. Strategies to improve compliance should focus on psychosocial risk factors pertaining to early psychologic reactions to transplantation, the quality of family relationships, and patients' styles of coping. These risk factors are each potentially modifiable through appropriate educational and supportive interventions.
尽管医疗依从性差是心脏移植后发病和死亡的主要风险因素，但目前尚无关于移植后治疗方案各组成部分不依从率的前瞻性数据。对于健康史、社会人口统计学或围手术期心理社会变量对长期依从性的影响知之甚少。
在101名心脏移植受者队列中，对移植后第一年的八个领域的依从性进行了检查。患者在移植后2、7和12个月接受了详细访谈。从家庭成员访谈和护士评估中获得了额外的确证信息。不依从的潜在预测因素来自病历审查和患者初始访谈。预测因素涉及心脏相关病史、精神病史、社会人口统计学变量和围手术期心理社会状况（心理适应、社会支持、应对策略）。
尽管不同时间点的不依从程度有所不同，但一年中持续不依从的发生率如下：运动37%；监测血压34%；药物治疗20%；吸烟19%；饮食18%；完成血液检查15%；门诊就诊9%；大量饮酒6%。随着时间的推移，大多数领域的依从性显著恶化（p<0.05）。与健康相关的背景和社会人口统计学特征对移植后依从性的任何领域均无显著影响。围手术期心理社会特征是不依从的强有力且显著的预测因素。
移植前对背景和人口统计学变量进行筛查对依从性结果的效用可能有限。改善依从性的策略应侧重于与移植早期心理反应、家庭关系质量和患者应对方式有关的心理社会风险因素。这些风险因素均可通过适当的教育和支持性干预进行潜在改变。
