Intentional and Unintentional Treatment Nonadherence in Patients With Systemic Lupus Erythematosus
Intentional and Unintentional Treatment Nonadherence in Patients With Systemic Lupus Erythematosus
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DOI：
10.1002/acr.20411
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发表时间：
2011-03-01
影响因子：
4.7
通讯作者：
Kaptein, A.
中科院分区：
文献类型：
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作者：
Daleboudt, Gabrielle M. N.;Broadbent, Elizabeth;Kaptein, A.
目标。如果患者没有按照医生的处方服药，他们可能会被定义为不依从者。不依从性的决定因素在患者组之间和组内可能有所不同。这项研究调查了系统性红斑狼疮(SLE)患者故意和无意不依从性的程度，以及不依从性与心理和医学参数的关系。这项研究包括106名患者，他们正在接受至少一种免疫抑制剂的治疗，以控制他们的SLE。获得了自我报告的依从性水平以及故意和无意不依从性的衡量标准。完成了问卷调查，以评估依从性与认知功能问题、对药物的信念、疾病感知、情绪健康和疾病特征之间的关系。总患者组的平均自我报告依从率为86.7%。至少46.2%的患者报告了至少偶尔的故意不依从性，58.5%的患者至少偶尔无意地不依从性。认知功能问题、对药物不良反应的担忧和年龄较小是(不)坚持的最强预测因素。受系统性红斑狼疮情绪影响的患者更有可能报告低依从性，但在考虑其他变量后，这不是一个显著的预测因素。疾病特征与依从性指标无关。尽管SLE患者报告的平均依从性很高，但他们通常报告故意和非故意的不依从性。坚持与认知和情感都有关。可以通过瞄准情绪和认知功能以及微调医患沟通来解决患者对药物的个人担忧来减少不依从性。
Objective. Patients may be defined as nonadherent if they do not take their medications as prescribed by their physicians. Determinants of nonadherence may vary between and within patient groups. This study investigated the extent to which patients with systemic lupus erythematosus (SLE) show intentional and unintentional nonadherence, and the associations of nonadherence with psychological and medical parameters.Methods. The study included 106 patients who were receiving at least one immunosuppressive agent to control their SLE. Level of self-reported adherence and a measure of both intentional and unintentional nonadherence were obtained. Questionnaires were completed to assess associations between adherence and problems with cognitive functioning, beliefs about medicines, illness perceptions, emotional health, and disease characteristics.Results. The mean self-reported adherence rate for the total patient group was 86.7%. At least occasional intentional nonadherence was reported by 46.2% of patients and 58.5% of patients were at least occasionally unintentionally nonadherent. Problems with cognitive functioning, concerns about adverse effects of medication, and younger age were the strongest predictors of (non)adherence. Patients who were emotionally affected by their SLE were more likely to report low adherence, but this was not a significant predictor after accounting for other variables. Disease characteristics showed no relationship to measures of adherence.Conclusion. Although SLE patients reported high levels of adherence on average, they commonly reported intentional and unintentional nonadherence. Adherence was associated with both cognitions and emotions. Nonadherence may be reduced by targeting emotional and cognitive functioning and by fine tuning doctor-patient communication to address patients' individual concerns about their medications.