BRIEF REPORT: The burden of diabetes therapy - Implications for the design of effective patient-centered treatment regimens
BRIEF REPORT: The burden of diabetes therapy - Implications for the design of effective patient-centered treatment regimens
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DOI：
10.1111/j.1525-1497.2005.0117.x
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发表时间：
2005-05-01
影响因子：
5.7
通讯作者：
Hofer, TP
中科院分区：
文献类型：
--
作者：
Vijan, S;Hayward, RA;Hofer, TP
背景：糖尿病的管理，尤其是血糖的管理，可能是复杂和繁重的。目的：评估患者对治疗负担及其对自我管理的影响的看法。研究对象：退伍军人2型糖尿病患者。设计：邮寄调查。测量：患者描述他们对糖尿病治疗负担、依从性、临床和人口学状况的看法。结果：有效率为67%(n=1,653)。患者认为服药是负担最轻的治疗，胰岛素是最沉重的负担。如果患者有治疗经验，胰岛素负担的评级较低。对处方治疗的依从性差异很大；例如，患者比其他自我管理领域更严格地遵循药物建议。多因素分析显示，患者对治疗负担的评分是影响患者依从性的主要因素。结论：患者认为注射胰岛素方案负担很大，尽管这种负担会因经验而减轻。坚持自我管理与对治疗负担的看法密切相关。糖尿病相关治疗的负担可能是在许多护理环境中看到的次佳血糖控制的来源。提供者应该考虑特定患者的治疗负担及其对依从性的影响，作为设计有效治疗方案的决策过程的一部分。
BACKGROUND: Management of diabetes, and in particular blood glucose, can be complex and burdensome.OBJECTIVE: To evaluate patient views of the burdens of therapy and its impact on self-management.PATIENTS: Veteran patients with type 2 diabetes.DESIGN: Mailed survey.MEASUREMENTS: Patients described their views of the burden of diabetes treatments, adherence, and clinical and demographic status. Factors associated with ratings of burden and adherence to therapy were examined using multivariate regression methods.RESULTS: The response rate was 67% (n=1,653). Patients viewed pills as the least burdensome treatment and insulin as the most burdensome. Ratings of the burden of insulin were lower if a patient had prior experience with therapy. Adherence to prescribed therapy varied substantially; for example, patients followed medication recommendations more closely than other areas of self-management. Multivariate analyses showed that the main predictor of adherence was patients' ratings of the burden of therapy.CONCLUSIONS: Injected insulin regimens are viewed as highly burdensome by patients, although this burden is attenuated by experience. Adherence to self-management is strongly and independently correlated with views of treatment burden. The burden of diabetes-related treatments may be a source of suboptimal glucose control seen in many care settings. Providers should consider the burden of treatment for a particular patient and its impact on adherence as part of a decision-making process to design effective treatment regimens.