Predictors of adherence to diabetes medications: the role of disease and medication beliefs
Predictors of adherence to diabetes medications: the role of disease and medication beliefs
复制标题
DOI：
10.1007/s10865-009-9202-y
复制
发表时间：
2009-06-01
影响因子：
3.1
通讯作者：
Halm, Ethan A.
中科院分区：
文献类型：
--
作者：
Mann, Devin M.;Ponieman, Diego;Halm, Ethan A.
尽管药物治疗在糖尿病管理中有效，但依从性差的比例仍然很高。本研究的目的是确定潜在的可改变的患者疾病和药物治疗信念与糖尿病患者的药物治疗依从性差。从纽约市的一家城市初级保健诊所招募了一组糖尿病患者。用英语或西班牙语对患者进行访谈，内容包括：疾病信念、药物信念、治疗方案复杂性、糖尿病知识、抑郁、自我效能和药物依从性（Morisky量表）。Logistic回归用于确定药物依从性差的多变量预测因素（Morisky > 1）。患者（n = 151）平均患有糖尿病13年，平均HgA 1C为7.6（SD 1.7）。四分之一（28%）的患者对糖尿病药物的依从性较差。在多变量分析中，药物治疗依从性差的预测因素是：相信只有当你的血糖高时你才有糖尿病（OR = 7.4;2 ~ 27.2），认为血糖正常时不需服药（OR = 3.5;0.9-13.7），担心糖尿病药物的副作用（OR = 3.3;1.3-8.7）、对控制糖尿病缺乏信心（OR = 2.8;1.1-7.1）、感觉药物难以服用（OR = 14.0;4.4-44.6）。与糖尿病慢性病模型不一致的疾病和药物治疗信念是药物治疗依从性差的重要预测因素。这些次优的信念是潜在的修改和教育干预，以改善糖尿病自我管理的逻辑目标。
Despite the effectiveness of drug therapy in diabetes management high rates of poor adherence persist. The purpose of this study was to identify potentially modifiable patient disease and medication beliefs associated with poor medication adherence among people with diabetes. A cohort of patients with diabetes was recruited from an urban primary-care clinic in New York City. Patients were interviewed in English or Spanish about: disease beliefs, medication beliefs, regimen complexity, diabetes knowledge, depression, self-efficacy, and medication adherence (Morisky scale). Logistic regression was used to identify multivariate predictors of poor medication adherence (Morisky > 1). Patients (n = 151) had diabetes for an average of 13 years with a mean HgA1C of 7.6 (SD 1.7). One-in-four (28%) were poor adherers to their diabetes medicines. In multivariate analyses, predictors of poor medication adherence were: believing you have diabetes only when your sugar is high (OR = 7.4;2-27.2), saying there was no need to take medicine when the glucose was normal (OR = 3.5;0.9-13.7), worrying about side-effects of diabetes medicines (OR = 3.3;1.3-8.7), lack of self-confidence in controlling diabetes (OR = 2.8;1.1-7.1), and feeling medicines are hard to take (OR = 14.0;4.4-44.6). Disease and medication beliefs inconsistent with a chronic disease model of diabetes were significant predictors of poor medication adherence. These suboptimal beliefs are potentially modifiable and are logical targets for educational interventions to improve diabetes self-management.