Association Between Patient-Clinician Relationships and Adherence to Antihypertensive Medications Among Black Adults: An Observational Study Design.
Association Between Patient-Clinician Relationships and Adherence to Antihypertensive Medications Among Black Adults: An Observational Study Design.
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DOI：
10.1161/jaha.120.019943
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发表时间：
2021-07-20
影响因子：
5.4
通讯作者：
Donneyong MM
中科院分区：
文献类型：
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作者：
Chang TJ;Bridges JFP;Bynum M;Jackson JW;Joseph JJ;Fischer MA;Lu B;Donneyong MM
我们评估了患者-临床医生关系（沟通和参与共同决策[SDM]）与抗高血压药物依从性之间的相关性。分析了2010年至2017年的医疗支出小组调查（MEPS）数据。采用回顾性队列研究设计，建立一个抗高血压药物的流行和新使用者队列。我们定义了患者-临床医生沟通和参与SDM的结构，这些结构来自患者对第一年调查期间关于满意度和获得护理的标准问卷的回答。使用第二年调查期间收集的经验证的自我报告药物补充信息计算药物补充依从性;依从性定义为药物补充依从性≥ 80%。使用调查加权多变量校正logistic回归模型测量患者-临床医生结构与依从性之间相关性的比值比（OR）和95% CI。我们的分析涉及2571例黑人成年高血压患者（平均年龄58岁; SD，14岁），他们要么是持续使用（n=1788），要么是新使用（n=783）降压药物。45%（n=1145）和43%（n=1016）的样本分别报告了高水平的沟通和参与SDM。在调整多个协变量后，高与低患者-临床医生沟通（OR，1.38; 95% CI，1.14-1.67）和参与SDM（OR，1.32; 95% CI，1.08-1.61）均与抗高血压药物的依从性相关。这些相关性在新使用抗高血压药物的亚组中持续存在。患者与临床医生的沟通和参与SDM是最佳抗高血压药物依从性的重要预测因素，应作为改善黑人高血压成人依从性的目标。
We assessed the associations between patient‐clinician relationships (communication and involvement in shared decision‐making [SDM]) and adherence to antihypertensive medications. The 2010 to 2017 Medical Expenditure Panel Survey (MEPS) data were analyzed. A retrospective cohort study design was used to create a cohort of prevalent and new users of antihypertensive medications. We defined constructs of patient‐clinician communication and involvement in SDM from patient responses to the standard questionnaires about satisfaction and access to care during the first year of surveys. Verified self‐reported medication refill information collected during the second year of surveys was used to calculate medication refill adherence; adherence was defined as medication refill adherence ≥80%. Survey‐weighted multivariable‐adjusted logistic regression models were used to measure the odds ratio (OR) and 95% CI for the association between both patient‐clinician constructs and adherence. Our analysis involved 2571 Black adult patients with hypertension (mean age of 58 years; SD, 14 years) who were either persistent (n=1788) or new users (n=783) of antihypertensive medications. Forty‐five percent (n=1145) and 43% (n=1016) of the sample reported having high levels of communication and involvement in SDM, respectively. High, versus low, patient‐clinician communication (OR, 1.38; 95% CI, 1.14–1.67) and involvement in SDM (OR, 1.32; 95% CI, 1.08–1.61) were both associated with adherence to antihypertensives after adjusting for multiple covariates. These associations persisted among a subgroup of new users of antihypertensive medications. Patient‐clinician communication and involvement in SDM are important predictors of optimal adherence to antihypertensive medication and should be targeted for improving adherence among Black adults with hypertension.