Nielsen B, Nielsen A S, Wraae O
Department of Psychiatry, Odense University Hospital, Denmark.
J Nerv Ment Dis. 1998 Dec;186(12):752-60. doi: 10.1097/00005053-199812000-00003.
In chronic medical disorders, patient compliance is very poor and often less than 50%. The purpose of this investigation was to determine whether the proper matching of patient, treatment, and therapist would improve patient compliance in the outpatient treatment of alcoholics. We randomly placed 119 alcoholics who had commenced protracted outpatient treatment for alcoholism in either low or high structured treatments. These 119 patients were offered 12 months of individual treatment. Interruption of this treatment was recorded as noncompliance. The treatment courses were expressed in survival curves. The consequence of compliance for long-term prognosis was described by means of the Addiction Severity Index. The form of treatment in itself had no importance for compliance. However, correct matching of a patient and a treatment structure resulted in a compliance rate of 63% as opposed to 38% compliance among mismatched patients. Twenty-four months after the initiation of treatment, patients in the compliance group had a significantly higher level of function than those in the noncompliance group. Our investigation of alcoholics involved in outpatient treatment shows that the correct matching of patients and treatment structure improves compliance and long-term prognosis. It is hoped that the present investigation will generate interest in future research on correct matching to gain improved compliance in patients with a chronic medical disorder.
在慢性疾病中,患者的依从性很差,通常低于50%。本研究的目的是确定患者、治疗方法和治疗师的合理匹配是否会提高酗酒者门诊治疗的患者依从性。我们将119名开始接受长期酗酒门诊治疗的酗酒者随机分为低结构化治疗组或高结构化治疗组。这119名患者接受为期12个月的个体治疗。治疗中断被记录为不依从。治疗过程用生存曲线表示。通过成瘾严重程度指数描述依从性对长期预后的影响。治疗形式本身对依从性并不重要。然而,患者与治疗结构的正确匹配导致依从率为63%,而不匹配患者的依从率为38%。治疗开始24个月后,依从组患者的功能水平明显高于不依从组。我们对参与门诊治疗的酗酒者的研究表明,患者与治疗结构的正确匹配可提高依从性和长期预后。希望本研究能激发未来对正确匹配的研究兴趣,以提高慢性疾病患者的依从性。