Effect of a system-oriented intervention on compliance problems in schizophrenia: a pragmatic controlled trial.

IF 3.6 Q1 PSYCHIATRY Schizophrenia Research and Treatment Pub Date : 2014-01-01 Epub Date: 2014-06-02 DOI:10.1155/2014/789403
Hanne Skarsholm, Henrik Stoevring, Bent Nielsen
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引用次数: 4

Abstract

Background. Numerous studies have been conducted with a view to developing strategies for improvement of medical compliance in patients with schizophrenia. All of the studies conducted so far have had an individual approach to compliance based on the assumption that noncompliance is determined individually due to inappropriate behavior in the patient. We conducted a pragmatic controlled trial with a system-oriented approach, to provide a new perspective on compliance and test the efficacy of a multifactorial intervention at the system level in a routine clinical setting, an approach that has not previously been used for the improvement of compliance. Methods. 30 patients were allocated to the system-oriented therapy and 40 patients were allocated to the reference intervention, which consisted of individually based compliance therapy. The follow-up period was six months. Primary endpoint was improvement in compliance, measured by improvement in a compliance scale specifically developed for the project. Results. When accounting for missing values with a multiple imputation approach, we found a tendency toward a difference in both the compliance scale and PANSS favoring the system-oriented therapy, although it did not reach statistical significance. A significant difference in incidence of adverse events and time to first readmission was found. Attrition rates were significantly higher in the reference group and nonsignificant among individuals with lower compliance, which may have diluted effect estimates. This was reflected by significant differences found in an analysis based on a last observation carried forward approach. Conclusion. This study suggests that compliance problems are better solved by a multifactorial intervention at the system level than at the individual level.

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系统导向干预对精神分裂症患者依从性问题的影响:一项实用对照试验。
背景。为了制定改善精神分裂症患者医疗依从性的战略,进行了许多研究。到目前为止进行的所有研究都采用了一种个体方法来确定依从性,这种方法基于这样的假设:不依从性是由于患者的不当行为而单独确定的。我们采用系统导向的方法进行了一项实用的对照试验,以提供对依从性的新视角,并在常规临床环境中测试系统层面多因素干预的有效性,这是一种以前未用于改善依从性的方法。方法:30例患者被分配到系统导向治疗组,40例患者被分配到参考干预组,参考干预组由基于个体的依从性治疗组成。随访期为6个月。主要终点是依从性的改善,通过专门为项目开发的依从性量表的改善来衡量。结果。当用多重归算方法考虑缺失值时,我们发现依从性量表和PANSS的差异倾向于支持系统导向的治疗,尽管没有达到统计学意义。不良事件的发生率和第一次再入院的时间有显著差异。参考组的损耗率显著较高,而依从性较低的个体的损耗率不显著,这可能稀释了效应估计。在基于最后观察结转方法的分析中发现的显著差异反映了这一点。结论。本研究认为,系统层面的多因素干预比个人层面的多因素干预更能解决依从性问题。
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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
2
审稿时长
14 weeks
期刊介绍: Schizophrenia Research and Treatment is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to all aspects of schizophrenia.
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