杭州市余杭区社区管理高血压病患者不同服药情况对血压控制的影响

目的探索高血压病患者不同服药情况对血压控制的影响,为防治对策提供依据。方法利用2009年杭州市余杭区4个示范社区高血压病患者随访记录。按照年度内服药时间和血压测定结果,服药分规则、间断、偶治;血压控制分优良、尚可、不良。分析不同服药时间的长、短,对血压控制的效果影响。对有关数据进行χ2检验,P〈0.05为差异有统计学意义。结果共调查社区管理的高血压病病患者800例,规则服药率66.2%,影响规则服药依从性的主要与个体的患病年限有关,而性别、年龄差异无统计学意义。高血压病患者血压控制率为64.4%,规则和不规则服药患者的血压控制率分别为79.8%和34.1%,差异有统计学意义（P〈0.01,RR=2.34）。结论坚持规则服药对高血压病患者的血压控制是必要的,社区随访中提高患者规则服药依从性对血压控制具有重要意义。     

社区糖尿病患者服药依从性水平及其影响因素分析

目的了解糖尿病患者服药依从性现状及其影响因素,为进一步开展糖尿病的社区干预工作提供依据。方法对300例大庆地区的社区糖尿病患者进行治疗依从性问卷调查,评价依从性水平,分析患者服药依从性的影响因素。结果服药依从性好的患者占48.3%。服药依从性与其糖尿病知识度、重视自身健康、社区管理方式的种类和时间呈正相关。结论通过开展健康教育、个性化生活方式指导、健康档案管理和定期随访为一体的、综合性规范化的社区管理,提高糖尿病患者的服药依从性。     

Achieving Patient Buy-In and Long Term Compliance with Antihypertensive Treatment

Noncompliance is a major problem in antihypertensive treatment. Up to 50% of patients are noncompliant after 1 year and 85% after 5 years. Current approaches for predicting compliance are based on patient demographics, medication characteristics and clinical factors, health beliefs and the quality of patient-provider communication. All of these factors together predict compliance only less than half the time, indicating that over half of the patients in disease management programmes may not buy-in to their treatment.A new approach views compliance as behaviour change that takes place over time. Patients move through 5 stages in their ‘readiness to comply’. Our study of over 700 patients with hypertension using brief self-report measures to assess their ‘readiness to comply’ found a highly significant relationship between ‘readiness to comply’ and reported compliance. Clinicians can increase patient buy-in and long term compliance by assessing their patients ’stage-of-change’ using validated measures and then matching their interventions to each patient’s ‘readiness to comply’.     

Treatment Expectations in Hypertension

Hypertension, an insidious condition affecting approximately 50 million US adults, remains a central factor contributing to cardiac and other target organ disease. Despite increased detection and numerous therapeutic advances, three out of four people with hypertension in the US have uncontrolled or poorly controlled blood pressure. While hypertension is a leading reason for primary care office visits and antihypertensive medications are widely prescribed, most individuals are not achieving goal systolic/diastolic blood pressure of 140/90mm Hg or less. While the definition of adequate blood pressure control varies in different countries, the problem of inadequate control is universal. Numerous barriers contributing to the suboptimal health outcomes have been recognized, including issues related to healthcare providers as well as patient compliance with medication and lifestyle changes.Recently, healthcare provider systems and health plans have turned to disease management strategies to better address quality and outcomes issues in hypertension management. Disease management, a systematic clinical improvement process, encompasses provider and patient education employing national or locally developed best practice guidelines and behavioral interventions coupled with close monitoring of clinical processes and outcomes of care. Disease management programs seek to define a comprehensive and coordinated approach to care across multiple providers and patient subgroups. Through risk assessment and stratification, patients at higher risk of complications can be identified, and customized intensive care support can be offered. Other types of intervention for lower risk individuals include brief visits with a cardiovascular educator or care manager, group classes, or self-instructional programs. Several successful programs initiated by healthcare systems and health plans are described.Adequate blood pressure control is essential to reduce cardiac, renal, and stroke disease later in life. However, large numbers of individuals must be effectively managed for years or decades to achieve reductions in complications and cost savings. Unlike more acute conditions that frequently result in hospitalization and loss of function, the immediate cost offsets of hypertension disease management efforts are less defined, although the eventual savings to society could be vast. Less costly methods to promote healthy outcomes across large, relatively stable populations are needed. Automated systems employing clinical decision support at the point of care and internet-based patient support strategies offer the hope that comprehensive, individualized disease management for hypertension can be affordable as well as effective. In the meantime, the fact that the National Committee on Quality Assurance has included blood pressure control as a future measure of health plan performance will almost certainly lead to the expanded development of hypertension disease management initiatives.     

Patient compliance with antihypertensive medication.

Self-reported medication taking compliance behavior of 132 high blood pressure patients was analyzed using an expanded version of the health belief model. Subjects were selected through random sampling procedures from regular hypertension program sessions at a large urban hospital. A questionnaire was constructed to measure the model components, and interviews were conducted with each patient. Bivariate analysis showed that control over health matters, dependence on providers, perceived barriers, duration of treatment, and others' nonconfirming experience were significantly related to compliance (p < .05). Log-linear multivariate analysis revealed that three of these five variables--control over health matters, perceived barriers, and duration of treatment--contributed independently to patient compliance. Self-reported medication taking was significantly related to blood pressure control (p < .02). These data provide the basis for developing interventions for providers to facilitate the medication taking behavior of clinic patients.     

耐多药肺结核服药管理模式对患者服药依从性的效果研究

目的研究耐多药肺结核服药管理模式对患者服药依从性的效果。方法在2018年1月—2019年6月期间该院收治的耐多药肺结核患者46例,根据患者的入院顺序进行分组,较早入院的23例患者为对照组并接受常规护理,余下23例患者为观察组,护理期间落实服药管理模式,通过对比两组患者的服药依从性、不规则治疗的原因以及治疗效果,综合分析其应用价值。结果观察组中出现不规则用药的患者明显少于对照组(P<0.05),不规则用药的原因有缺乏用药监督、用药后出现不良反应、治疗费用较高、缺乏治疗信心等。对比两组患者的痰细菌转阴率以及病灶吸收率观察组均具有显著优势(P<0.05)。结论耐多药肺结核患者的治疗中开展服药管理模式能够显著有效提升服药依从性,减少不规则用药情况的出现,对于提升治疗效果具有重要意义,可以作为耐多药肺结核的首选护理方案。     

Excess Healthcare Costs Associated with Excess Health Risks in Diseased and Non-Diseased Health Risk Appraisal Participants

Background: Concerns regarding the effectiveness and impact of disease management are largely based on disease compliance measures. Although disease management programs have measured improvements in compliance and quality of life and cost savings from reductions in hospitalizations and emergency room visits, few programs have focused on changing behavioral health risks not directly related to the specific disease. The basic relationship between behavioral health risks and healthcare costs shows that those individuals with more high-risk behaviors are associated with higher healthcare costs compared with those with low-risk behaviors. The concept of excess costs associated with excess risks is a calculation of theoretical maximum percent savings for an entire group assuming everyone reduces to low risk, and changes in healthcare costs follow the changes in risks. Objective: To establish the magnitude of excess healthcare costs associated with excess health risks, given a diagnosed chronic disease. Methods: 135 251 current and retired employees of General Motors Corporation who had completed a Health Risk Appraisal (HRA) were evaluated. Participants were continuously enrolled in traditional or Preferred Provider Organization (PPO) medical plans from 1996 to 1999 and had completed at least one HRA between 1996 and 1998. Results: Those with and without self-reported disease averaged 19.2 and 9.1% excess healthcare costs associated with excess health risks, respectively. However, the magnitude of the impact differed across age groups and diseases. Individuals less than 45 years of age with self-reported disease were most affected by the presence of additional health risks (44% excess costs) while those aged ≥65 years without disease were least affected (8.2% excess costs). Among those with diseases, those with diabetes mellitus and bronchitis/emphysema were most affected (19.2 and 21.0%, respectively). Conclusions: Disease management programs should ideally provide a systematic approach to assist patients with interventions that improve overall health, as well as focusing on disease compliance measures. The implications for disease management programs are that, even given the presence of disease, promoting and/or maintaining low-risk status can result in potential cost savings.     

Can we alter physician behavior by educational methods? Lessons learned from studies of the management and follow-up of hypertension

INTRODUCTION: As expectations for effective continuing medical education (CME) grow, so, too, does the need to identify relationships among educational methods, physician performance, and patient outcomes associated with specific disease entities. Thus, we set out to review the literature on the effectiveness of physician educational interventions in the management and follow-up of hypertension. METHOD: We searched PubMed and the Research and Development Resource Base in Continuing Medical Education for randomized controlled trials of physician educational interventions. We included only those studies that (a) used replicable educational interventions with > 50% physician involvement and that employed objective methods to measure physician behavior change or patient outcomes, (b) indicated a physician or patient dropout rate of < 30%, and (c) followed outcome measurement for > 30 days. Studies were designated "positive" if one or more of the primary outcome measures demonstrated a statistically significant change in physician performance or health care outcome. RESULTS: We found 12 studies in which 7 different physician educational interventions were employed, alone or in combination, including reminders (computer or chart), formal CME, computerized decision support systems/risk stratification, printed educational materials, academic detailing, continuous quality improvement projects, and disease management aids in patient charts. Of the 12, 7 were positive and 4 were negative. One had mixed results. DISCUSSION: Although physician educational interventions, especially reminders, improved the follow-up of hypertension, they were ineffective in changing blood pressure levels. However, they may have some utility in improving compliance with guideline recommendations.     

Older adult medication compliance: integrated review of randomized controlled trials

OBJECTIVE: To examine interventions and outcomes of medication compliance studies in older adults. METHODS: An integrated review of randomized controlled trials was completed. RESULTS: Thirty-one of 57 studies reported significantly greater medication compliance in treatment subjects versus control subjects. Interventions included counseling, education, self-medication programs, cues and organizers, and decreasing dosing frequency. Decreasing dosing frequency and self-medication programs were successful, although not frequently evaluated. CONCLUSIONS: Future studies should address methodologic flaws (eg, small sample sizes, measurement validity issues), test theory-based interventions delivered by diverse providers, evaluate intervention dose, and examine persistence of compliance behavior changes.     

健康信念模式对消化性溃疡干预效果分析

目的探讨健康信念模式对消化性溃疡患者干预的效果。方法采用方便抽样的方法选取消化性溃疡患者100例,均为经内窥镜下确诊且无严重并发症的消化性溃疡患者,在对其给予有目的、有计划、有评价的健康行为干预后,观察患者预防与治疗顺从性的改变及其对疾病转归的影响。结果经过健康教育干预后,100例患者对知识掌握、自我保健能力、预防和治疗的改变及其对疗效影响显著（P〈O．01）。结论健康信念模式对提高消化性溃疡患者预防与治疗顺从性的改变及其对疾病转归的影响显著;有效的健康行为干预能提高患者预防与治疗顺从率,改善疗效。     

The Effectiveness of Asthma Nurse Intervention

Asthma morbidity remains high worldwide despite the introduction of national guidelines for management and the increase in specially trained asthma nurses. Current interventions have not led to a demonstrable reduction in hospitalizations and emergency department visits in adult asthma. The role of the asthma nurse must include addressing issues of compliance as part of a more holistic approach to asthma management.Previous studies have demonstrated that the asthma nurse can play a pivotal role in educating and supporting the patient in self-management strategies and the hospital setting has been shown to be an appropriate setting in which to target those with poor symptom control. Issues of compliance must be addressed within the domains of patients’ perception of their asthma, accurate assessment of prior knowledge, education to promote changes in behavior and appropriate self-management strategies, as well as giving consideration to influences such as culture on self-management behavior.The asthma nurse is ideally placed to accurately assess and educate patients with asthma on how to manage their symptoms. However, education must be an ongoing process for both patient and educator. Any interventions offered must be based on up-to-date evidence with proven clinical effectiveness if improved long-term outcomes are to be achieved.     

The impact of the laboratory on disease management.

The laboratory has been an integral part of the continuum of care for centuries. It has been said that 60%-70% of critical decisions in diagnosis and treatment involve quantifiable laboratory data. Disease management (DM) outcomes can be influenced through effective use of this information. Today's laboratory supports DM in the following ways: disease screening for early identification of disease; predictive measures to identify those at risk for a disease; disease identification to diagnose and confirm a disease; treatment which can be initially identified or changed based upon the results of a lab test; and compliance/surveillance to identify whether a treatment is working or if the appropriate level of medication has been prescribed for a patient. This paper discusses the importance of laboratory testing in all phases of DM.     

冠心病PCI术后患者用药依从性的护理研究现状（综述）

该文综述了冠心病PCI术后患者用药依从性的现状,从建立良好护患关系、多种形式的健康教育、循证护理、纠正信念和态度、有效的家庭支持和身心健康管理系统6个方面,实施系统有效护理干预,提高冠心病PCI术后患者的用药依从性,减少心血管事件,提高患者生活质量,延长寿命。     

辽宁省农村高血压患者服药依从性与血压控制水平研究

目的评价辽宁省农村高血压患者服药依从性及其与血压控制水平之间的关系。方法按照多级整群随机抽样原则,采用统一问卷调查辽宁省五县386名≥35岁高血压服药患者的服药顺应性、服药持续性、服药依从性及血压持续控制水平。结果随年龄增加血压控制率降低,70岁以上患者血压控制率低于低年龄组(OR=0.31,95%CI:0.12～0.80)。服药持续性、顺应性和依从性良好比例分别为51.30%,31.09%和22.28%。服药控制率随服药顺应性(OR=0.35,95%CI:0.18～0.69)和依从性水平(OR=0.45,95%CI:0.21～0.94)降低而下降,仅8.03%的服药患者血压持续控制优良。结论辽宁省农村高血压患者服药依从性差,致使血压控制不理想。需采取综合干预措施提高血压控制率,降低并发症发生。     

The use of incentives to reinforce medication adherence

ObjectivePoor medication adherence is a longstanding problem, and is especially pertinent for individuals with chronic conditions or diseases. Adherence to medications can improve patient outcomes and greatly reduce the cost of care. The purpose of the present review is to describe the literature on the use of incentives as applied to the problem of medication adherence.MethodsWe conducted a systematic review of peer-reviewed empirical evaluations of incentives provided to patients contingent upon medication adherence.ResultsThis review suggests that incentive-based medication adherence interventions can be very effective, but there are few controlled studies. The studies on incentive-based medication adherence interventions most commonly feature patients taking medication for drug or alcohol dependence, HIV, or latent tuberculosis. Across studies that reported percent adherence comparisons, incentives increased adherence by a mean of 20 percentage points, but effects varied widely. Cross-study comparisons indicate a positive relationship between the value of the incentive and the impact of the intervention. Post-intervention evaluations were rare, but tended to find that adherence effects diminish after the interventions are discontinued.ConclusionsIncentive-based medication adherence interventions are promising but understudied. A significant challenge for research in this area is the development of sustainable and cost-effective long-term interventions.     

Case study of American Healthways' diabetes disease management program

Disease management has been defined as a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant (Disease Management Association of America, 2005). The purpose of this article is to provide an overview of the diabetes disease management program offered by American Healthways (AMHC) and highlight recently reported results of this program (Villagra, 2004a; Espinet et al., 2005).