Factors associated with medication nonadherence in patients with COPD
Factors associated with medication nonadherence in patients with COPD
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DOI：
10.1378/chest.128.5.3198
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发表时间：
2005-11-01
期刊：
影响因子：
9.6
通讯作者：
Stewart, K
中科院分区：
文献类型：
--
作者：
George, J;Kong, DCM;Stewart, K
研究目的：确定COPD患者药物依从性的预测因素，并将自我报告良好依从性的COPD患者与报告药物依从性欠佳的患者的健康信念、经验和行为进行对比。设计图：横断面自填问卷。设置：门诊护理。参与者：通过呼吸支持小组和肺康复数据库确定的慢性呼吸系统疾病患者。测量和结果：一份30项问卷，包括与健康信念、经历、和行为沿着一个有效的自我报告的依从性措施-药物依从性报告量表（MARS）-对525名患有慢性肺部疾病的非卧床患者进行了治疗。共收到276份可用答复（52.6%）。受访者的平均年龄为71岁，男性患者略多（54.4%）。COPD是90.6%的受访者的基础疾病;三分之二的受访者有合并症。在61.2%的病例中，呼吸系统疾病由全科医生和呼吸科专家共同管理。三分之一的受访者自我报告补充和替代医学的使用。受访者的MARS平均得分（+/- SD）为23.37 +/- 2.09。102例患者自我报告对MARS的依从性良好。在对疾病和治疗的了解、对治疗和医生的信任和满意度、对治疗的关注以及有意和无意偏离推荐治疗的差异在依从性和依从性较差的组之间被检测到。在多变量分析中，“我根据自己的感觉改变我推荐的治疗方法”和“我对我的药物感到困惑”被发现是不依从的重要独立预测因素。患者对疾病过程和推荐治疗的接受程度，对治疗的了解和信心，有效的患者-临床医生互动，和药物治疗的合理化对于COPD患者的最佳药物依从性至关重要。
Study objectives: To identify the predictors of medication adherence in patients with COPD and contrast the health beliefs, experiences, and behaviors of COPD patients self-reporting good adherence with those of patients reporting suboptimal adherence to their medications. Design: Cross-sectional self-administered questionnaire.Setting: Ambulatory care.Participants: Patients with chronic respiratory ailments identified through respiratory support groups and from a pulmonary rehabilitation database.Measurements and results: A 30-item questionnaire comprising items pertaining to health beliefs, experiences, and behaviors along with a valid self-reported measure of adherence-the medication adherence report scale (MARS)-was administered to 525 ambulatory patients with chronic lung conditions. A total of 276 usable responses were received (52.6%). The mean age of the respondents was 71 years, and there were slightly more male patients (54.4%). COPD was the underlying disease condition in 90.6% of the respondents; two thirds of the respondents had comorbid conditions. The respiratory condition was managed by both general practitioners and respiratory specialists in 61.2% of cases. One third of the respondents self-reported complementary and alternative medicine use. The mean score (+/- SD) on the MARS among the respondents was 23.37 +/- 2.09. One hundred two patients self-reported perfect adherence on the MARS. Differences in knowledge about the illness and treatment, faith in and satisfaction with the treatment and doctors, concerns about the treatment, and intentional and unintentional deviations from the recommended treatment were detected between the adherent and less adherent groups. In multivariate analysis, "I vary my recommended management based on how I am feeling" and "I get confused about my medications" were found to be significant independent predictors of nonadherence.Conclusions: Patients' acceptance of the disease process and recommended treatment, knowledge about and faith in the treatment, effective patient-clinician interaction, and routinization of drug therapy are critical for optimal medication adherence in patients with COPD.