Modifiable barriers to adherence to inhaled steroids among adults with asthma: It's not just black and white
Modifiable barriers to adherence to inhaled steroids among adults with asthma: It's not just black and white
复制标题
DOI：
10.1067/mai.2003.1479
复制
发表时间：
2003-06-01
影响因子：
14.2
通讯作者：
Feldman, HI
中科院分区：
文献类型：
--
作者：
Apter, AJ;Boston, RC;Feldman, HI
背景：社会行为因素影响成人哮喘患者对吸入性皮质类固醇(ICS)的依从性，并有必要探索作为依从性明显种族差异的解释。目的：本研究的目的是在一组非裔美国人和非非裔美国人中确定可能由医疗服务提供者改变的依从性障碍，并测试可改变的障碍作为对依从性的种族-种族差异的解释。方法：我们对85名患有中度或重度持续性哮喘的成年人(平均年龄47+/-15岁；女性61[72%]；非裔美国人55[65%])进行了一项队列研究，以确定可修改的依从性社会行为预测因素。这些是对ICS功能的了解，患者对与提供者沟通的充分性的感知，社会支持，态度(对ICS的风险/好处的感知)，抑郁，以及自我效能。依从性是根据电子监测数据计算的，即每12小时记录的剂量数量除以规定数量的平均值，截断为100%。在有序Logistic模型中，将既往依从性、基线症状严重程度和社会人口学作为固定混杂因素。结果：依从性为60%+/-30%。在双变量分析中，对ICS的良好态度(P=0.01)与更好的依从性相关。在不变的预测因素中，非裔美国人种族(P=.001)、较低的教育成就(P=.01)、较低的家庭收入(P=.002)和较多的基线症状(P=.003)与较差的遵从性相关。在多变量分析中，控制一成不变的预测因素，有利的态度与坚持有关。在非洲裔美国人和非非洲裔美国人中，有利的态度与更多的忠诚度有关。控制一成不变的因素，种族依附关系不是由可变因素中介的，而是经济因素(收入和保险)起中介作用。结论：态度与依恋密切相关，但不会中介种族-民族的影响。
Background: Sociobehavioral factors influence adherence to inhaled corticosteroid (ICS) in adults with asthma and warrant exploration as explanations of apparent racial disparities in adherence.Objective: The purposes of this study were to identify barriers to adherence, potentially modifiable by healthcare providers, in a group of African Americans and non-African Americans and to test modifiable barriers as explanations of racial-ethnic differences in adherence.Methods: We conducted a cohort study of 85 adults (mean age, 47 +/- 15 years; 61 [72%] female; 55 [65%] African American) with moderate or severe persistent asthma to determine modifiable sociobehavioral predictors of adherence. These were knowledge of the function of ICS, patient-perceived adequacy of communication with the provider, social support, attitude (perception of risks/benefits of ICS), depression, and self-efficacy. Adherence was calculated from electronic monitoring data as the mean of the number of doses recorded per 12 hours divided by the number prescribed, truncated at 100%. Past adherence, baseline severity of symptoms, and sociodemographics were treated as fixed confounders in ordinal logistic modeling.Results: Adherence was 60% +/- 30%. In bivariate analyses, favorable attitude to ICS (P = .01) was associated with better adherence. Of immutable predictors, African American race-ethnicity (P = .001), lower educational achievement (P = .01), lower household income (P = .002), and more baseline symptoms (P = .003) were associated with poorer adherence. In multivariable analysis, controlling for immutable predictors, favorable attitude was associated with adherence. Favorable attitude was associated with greater adherence in African Americans and non-African Americans. Controlling for immutable factors, the race-adherence relationship was not mediated by the mutable factors, but economic factors (income and insurance) were mediators.Conclusion: Attitude is strongly related to adherence but does not mediate the effect of race-ethnicity.