Association between perceived life chaos and medication adherence in a postmyocardial infarction population.
Association between perceived life chaos and medication adherence in a postmyocardial infarction population.
复制标题
心肌梗死后人群感知的生活混乱与药物依从性之间的关联。
DOI：
10.1161/circoutcomes.113.000435
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Bosworth,HaydenB
中科院分区：
文献类型：
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作者：
Zullig,LeahL;Shaw,RyanJ;Crowley,MatthewJ;Lindquist,Jennifer;Grambow,StevenC;Peterson,Eric;Shah,BimalR;Bosworth,HaydenB
背景坚持用药控制心血管疾病(CVD)的益处是明确的，但多项研究发现依从性差。生活混乱对服药依从性的影响尚不清楚。由于这是一种新的仪器应用，我们的初步目标是了解与混乱相关的患者因素。主要目的是评估一种用于测量生活混乱程度的工具与心血管疾病用药不依从性的关系。方法与结果使用一项正在进行的旨在改善心肌梗死后管理的随机试验的基线数据，多变量Logistic回归分析确定了生活混乱与心血管疾病用药不依从性之间的关联。406例患者在过去3年内有高血压和心肌梗死史。近43%的人报告在过去的一个月里没有坚持服用心血管疾病药物。单因素回归分析显示，不坚持服药(β=1.86；95%可信区间[CI]0.96~2.76)、女性性别(β=1.22；95%CI[0.22~2.24])、少数民族(β=1.72；95%CI[0.78~2.66])、高中以下文化程度(β=2.05；95%CI[0.71~3.39])、健康素养低(β=2.06；经济状况不佳(β=1.93；95%CI[0.87-3.00])。已婚(β=−2.0 9，95%CI[−3.0 3对−1.15])与低度生活混乱有关。随着混沌四分位数的增加，患者表现出更多的不依从性。在Logistic回归中，调整了性别、种族、婚姻状况、就业、教育、健康素养和经济状况，生活混乱每增加1个单位，报告药物不坚持的几率增加7%(优势比1.07；95%可信区间1.02-1.12)。结论我们的结果表明，生活混乱可能是药物依从性的重要决定因素。生活混乱筛查可以识别那些有未依从性风险的人。临床试验注册URL：http://www.clinicaltrials.gov.唯一标识：NCT000901277
BackgroundThe benefits of medication adherence to control cardiovascular disease (CVD) are well defined, yet multiple studies have identified poor adherence. The influence of life chaos on medication adherence is unknown. Because this is a novel application of an instrument, our preliminary objective was to understand patient factors associated with chaos. The main objective was to evaluate the extent to which an instrument designed to measure life chaos is associated with CVD-medication nonadherence.Methods and ResultsUsing baseline data from an ongoing randomized trial to improve postmyocardial infarction (MI) management, multivariable logistic regression identified the association between life chaos and CVD-medication nonadherence. Patients had hypertension and a myocardial infarction in the past 3 years (n=406). Nearly 43% reported CVD-medication nonadherence in the past month. In simple linear regression, the following were associated with higher life chaos: medication nonadherence (β=1.86; 95% confidence interval [CI], 0.96–2.76), female sex (β=1.22; 95% CI [0.22–2.24]), minority race (β=1.72; 95% CI [0.78–2.66]), having less than high school education (β=2.05; 95% CI [0.71–3.39]), low health literacy (β=2.06; 95% CI [0.86–3.26]), and inadequate financial status (β=1.93; 95% CI [0.87–3.00]). Being married (β=−2.09, 95% CI [−3.03 to −1.15]) was associated with lower life chaos. As chaos quartile increased, patients exhibited more nonadherence. In logistic regression, adjusting for sex, race, marital status, employment, education, health literacy, and financial status, a 1-unit life chaos increase was associated with a 7% increase (odds ratio, 1.07; 95% CI [1.02–1.12]) in odds of reporting medication nonadherence.ConclusionsOur results suggest that life chaos may be an important determinant of medication adherence. Life chaos screenings could identify those at risk for nonadherence.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT000901277