Potential risk factors for medication non-adherence in patients with chronic obstructive pulmonary disease (COPD)
Potential risk factors for medication non-adherence in patients with chronic obstructive pulmonary disease (COPD)
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DOI：
10.1007/s00228-012-1279-5
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发表时间：
2012-10-01
影响因子：
2.9
通讯作者：
McElnay, James C.
中科院分区：
文献类型：
--
作者：
Khdour, Maher R.;Hawwa, Ahmed F.;McElnay, James C.
旨在调查一系列人口统计和心理社会变量对二级护理机构管理的慢性阻塞性肺病 (COPD) 患者服药依从性的影响。从北爱尔兰一家门诊诊所招募的总共 173 名确诊为 COPD 的患者参与了这项研究。数据收集是通过面对面访谈和审查患者病历进行的。确定每位患者的社会和人口变量、共病、自我报告的药物依从性（Morisky 量表）、医院焦虑和抑郁 (HAD) 量表、COPD 知识、健康信念模型 (HBM) 和自我效能量表。参与者年龄为 67 +/- 9.7（平均值 +/- SD）岁，其中 56% 为女性，服用药物的平均值 (SD) 为 8.2 +/- 3.4。 29.5% 的患者对药物的依从性较低。人口统计变量（性别、年龄、婚姻状况、生活安排和职业）与依从性无关。另一方面，一系列临床和心理社会变量被发现与药物依从性相关，即对药物有效性的信念、COPD 的严重程度、吸烟状况、共存疾病的存在、抑郁情绪、自我效能、感知易感性和 HBM 内感知障碍 (p < 0.05)。 Logistic回归分析显示，在研究中，感知到的药物无效、存在共存疾病、抑郁情绪和感知障碍与药物不依从性独立相关（P < 0.05）。 COPD患者的依从性更多地受到患者对其健康和药物有效性的认知、是否存在抑郁情绪和共存疾病的影响，而不是受人口因素或疾病严重程度的影响。
To investigate the effect of a range of demographic and psychosocial variables on medication adherence in chronic obstructive pulmonary disease (COPD) patients managed in a secondary care setting.A total of 173 patients with a confirmed diagnosis of COPD, recruited from an outpatient clinic in Northern Ireland, participated in the study. Data collection was carried out via face-to-face interviews and through review of patients' medical charts. Social and demographic variables, co-morbidity, self-reported drug adherence (Morisky scale), Hospital Anxiety and Depression (HAD) scale, COPD knowledge, Health Belief Model (HBM) and self-efficacy scales were determined for each patient.Participants were aged 67 +/- 9.7 (mean +/- SD) years, 56 % female and took a mean (SD) of 8.2 +/- 3.4 drugs. Low adherence with medications was present in 29.5 % of the patients. Demographic variables (gender, age, marital status, living arrangements and occupation) were not associated with adherence. A range of clinical and psychosocial variables, on the other hand, were found to be associated with medication adherence, i.e. beliefs regarding medication effectiveness, severity of COPD, smoking status, presence of co-morbid illness, depressed mood, self-efficacy, perceived susceptibility and perceived barriers within the HBM (p < 0.05). Logistic regression analysis showed that perceived ineffectiveness of medication, presence of co-morbid illness, depressed mood and perceived barriers were independently associated with medication non-adherence in the study (P < 0.05).Adherence in COPD patients is influenced more by patients' perception of their health and medication effectiveness, the presence of depressed mood and co-morbid illness than by demographic factors or disease severity.