Measuring Medication Use, Obstacles, and Knowledge in Individuals With Cirrhosis.
Measuring Medication Use, Obstacles, and Knowledge in Individuals With Cirrhosis.
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衡量肝硬化患者的药物使用情况、障碍和知识。
DOI：
10.1016/j.cgh.2022.08.025
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Monahan,PatrickO
中科院分区：
文献类型：
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作者：
Desai,ArchitaP;Duzdar,Shahd;Stump,Timothy;Orman,EricS;Nephew,Lauren;Patidar,KavishR;Ghabril,MarwanS;Block,Geoffrey;Fallon,Michael;Chalasani,Naga;Monahan,PatrickO
背景与目的虽然患者的知识是可以改变的，但目前还没有广泛接受的工具来衡量患者在肝硬化护理过程中的理解。我们的目的是开发和验证“我的肝硬化教练”（MCC），个性化的，自我管理的问卷调查，以评估肝硬化相关的药物使用，障碍，和understanding.MethodsAdults肝硬化前瞻性招募3个三级中心从2016年7月至2020年7月。包括验证性因素分析的心理测量学被用来开发和验证最终的问卷。内容效度通过内容效度指数和专家绩效进行测量。判别效度进行了评估，通过比较各组之间的分数假设有不同的performance. ResultsMCC进行了测试，在一个不同的队列（n = 713），肝硬化及其并发症，包括腹水（45%）和肝性脑病（33%）与中位数模型为终末期肝病钠10（四分位数范围，9-15）。MCC的6因素模型很好地拟合了数据（近似均方根误差，0.22;比较拟合指数，0.96;标准化均方根残差，0.104;最终领域：药物使用和可及性，药物障碍，乳果糖使用，利尿剂使用，β受体阻滞剂使用和膳食钠使用）。MCC具有良好的内容效度（内容效度指数，81%-94%）和准确性（91%-100%）的专家评级。平均领域得分范围为1.1至2.6（范围：0-3; 3表示性能更好）。患有肝硬化并发症的患者在相关药物领域（即腹水利尿剂使用评分）的得分较高。与门诊患者相比，住院患者在除盐使用外的所有知识领域的得分均较高，并报告了更多的用药障碍。得分不同的收入，教育水平，并有一个成年人在home.ConclusionsIn一个大的，多样化的队列，我们验证了MCC，它可以作为标准化的药物使用和知识测量在肝硬化的临床实践和教育为基础的研究。
Background & AimsAlthough patient knowledge is modifiable, there are no widely accepted tools to measure patient understanding during cirrhosis care. We aimed to develop and validate “My Cirrhosis Coach” (MCC), a personalized, self-administered questionnaire to evaluate cirrhosis-related medication use, obstacles, and understanding.MethodsAdults with cirrhosis were prospectively enrolled at 3 tertiary centers from July 2016 through July 2020. Psychometrics including confirmatory factor analysis was used to develop and validate a final questionnaire. Content validity was measured via the content validity index and expert performance. Discriminant validity was assessed by comparing scores between groups hypothesized to have varying performance.ResultsThe MCC was tested in a diverse cohort (n = 713) with cirrhosis and its complications including ascites (45%) and hepatic encephalopathy (33%) with median Model for End-Stage Liver Disease-Sodium 10 (interquartile range, 9–15). A 6-factor model of the MCC fit the data well (root mean square error of approximation, 0.22; comparative fit index, 0.96; standardized root mean squared residual, 0.104; final domains: Medication Use & Accessibility, Medication Obstacles, Lactulose Use, Diuretic Use, Beta Blocker Use, and Dietary Sodium Use). The MCC had excellent content validity (content validity index, 81%–94%) and accuracy (91%–100%) ratings by experts. Mean domain scores ranged from 1.1 to 2.6 (range, 0–3; 3 indicating better performance). Those with a cirrhosis complication scored higher in the relevant medication domain (ie, diuretic use score in ascites). Compared with outpatients, inpatients scored higher in all knowledge domains except salt use and reported more medication obstacles. Scores differed by income, education level, and having an adult at home.ConclusionsIn a large, diverse cohort, we validated the MCC, which can serve to standardize medication use and knowledge measurement in clinical practice and education-based studies in cirrhosis.