Nageotte C, Sullivan G, Duan N, Camp P L
University of Illinois at Chicago, Department of Psychiatry, IL 60612, USA.
Soc Psychiatry Psychiatr Epidemiol. 1997 Feb;32(2):49-56. doi: 10.1007/BF00788920.
Medication non-compliance, a pervasive problem among persons with serious, chronic mental illness, has been linked to increased inpatient resources use in public mental health systems. The objective of this analysis was to determine which factors are associated with medication compliance in this population so that more appropriate screening and intervention programs can be designed. Using knowledge gained from clinical research on compliance in schizophrenia and research testing the Health Belief Model as a conceptual framework in studying compliance behavior, we conducted a secondary analysis of data collected in the Mississippi public mental health system in 1988. The study subjects were schizophrenic patients (n = 202), the majority of whom were low-income, African-American males. Data sources included structured interviews with patients and family members, as well as state hospital and community mental health clinic administrative records. Receipt of consistent outpatient mental health treatment and belief that one had a mental illness were significantly associated with higher levels of medication compliance in this population of seriously mentally ill patients. Our results suggest that screening programs to identify those at highest risk for non-compliance in this population might be more productive if they included a review of inpatient and outpatient mental health service utilization patterns, in addition to formal assessment of patients' attitudes and beliefs about their illness. This study illustrates an approach to examining predictors of a policy-relevant health behavior in a minority population within a public mental health system.
药物治疗依从性差是严重慢性精神疾病患者中普遍存在的问题，与公共精神卫生系统中住院资源使用增加有关。本分析的目的是确定哪些因素与该人群的药物治疗依从性相关，以便设计出更合适的筛查和干预项目。利用从精神分裂症治疗依从性的临床研究以及将健康信念模型作为研究依从行为的概念框架的研究中获得的知识，我们对1988年密西西比州公共精神卫生系统收集的数据进行了二次分析。研究对象为精神分裂症患者（n = 202），其中大多数是低收入非裔美国男性。数据来源包括对患者及其家庭成员的结构化访谈，以及州立医院和社区精神卫生诊所的行政记录。在这群严重精神疾病患者中，持续接受门诊精神卫生治疗以及认为自己患有精神疾病与较高的药物治疗依从性显著相关。我们的结果表明，在该人群中识别出依从性最差风险最高者的筛查项目，如果除了对患者对自身疾病的态度和信念进行正式评估外，还包括对住院和门诊精神卫生服务利用模式的审查，可能会更有成效。本研究说明了一种在公共精神卫生系统内的少数族裔人群中检查与政策相关的健康行为预测因素的方法。
