Sewitch Maida J, Abrahamowicz Michal, Barkun Alan, Bitton Alain, Wild Gary E, Cohen Albert, Dobkin Patricia L
Groupe de Recherche Interdisciplinaire en Santé, University of Montreal, Montreal, Quebec, Canada.
Am J Gastroenterol. 2003 Jul;98(7):1535-44. doi: 10.1111/j.1572-0241.2003.07522.x.
The aim of this study was to identify determinants of nonadherence to medication in outpatients with established inflammatory bowel disease (IBD).
Ten gastroenterologists and 153 of their IBD patients participated in this prospective study. Demographic, clinical, and psychosocial characteristics, as well as patient-physician discordance, were assessed at an office visit. Nonadherence to medication was assessed 2 wk later. Separate generalized estimating equations were used to identify determinants of nonadherence.
Physicians averaged 47.9 yr in age (range 30.1-57.5 yr), and 90% were male. Patients averaged 37.0 yr (SD = 15.1), and 87 (56.9%) were female. In all, 63 patients (41.2%) were nonadherent to medication; of these, 51 (81.0%) indicated unintentional nonadherence, 23 (36.5%) intentional nonadherence, and 11 (17.5%) both. Overall nonadherence was predicted by disease activity (OR = 0.55, p = 0.0022), new patient status (OR = 2.14, p = 0.0394), disease duration (OR = 0.50, p = 0.0001), and scheduling a follow-up appointment (OR = 0.30, p = 0.0059), whereas higher discordance on well-being was predictive only in psychologically nondistressed patients (p = 0.0026 for interaction). Unintentional nonadherence was predicted by age (OR = 0.97, p = 0.0072), new patient status (OR = 2.80, p = 0239), and higher discordance on well-being in psychologically nondistressed patients (p = 0.0504). Intentional nonadherence was predicted by disease duration (OR = 0.55, p = 0032), scheduling a follow-up appointment (OR = 0.12, p = 0.0001), certainty that medication would be helpful (OR = 0.99, p = 0.0409), and total patient-physician discordance (OR = 1.59, p =.0120).
These findings suggest that the therapeutic relationship, as well as individual clinical and psychosocial characteristics, influence adherence to medication.
本研究旨在确定已确诊的炎症性肠病（IBD）门诊患者药物治疗不依从性的决定因素。
10名胃肠病学家及其153例IBD患者参与了这项前瞻性研究。在门诊就诊时评估人口统计学、临床和心理社会特征，以及患者与医生之间的不一致性。2周后评估药物治疗不依从性。使用单独的广义估计方程来确定不依从性的决定因素。
医生的平均年龄为47.9岁（范围30.1 - 57.5岁），90%为男性。患者的平均年龄为37.0岁（标准差 = 15.1），87例（56.9%）为女性。总共有63例患者（41.2%）药物治疗不依从；其中，51例（81.0%）表示无意不依从，23例（36.5%）有意不依从，11例（17.5%）两者皆有。总体不依从性可由疾病活动度（比值比[OR] = 0.55，p = 0.0022）、新患者状态（OR = 2.14，p = 0.0394）、疾病持续时间（OR = 0.50，p = 0.0001）和安排随访预约（OR = 0.30，p = 0.0059）预测，而在幸福感方面较高的不一致性仅在心理无困扰的患者中具有预测性（交互作用p = 0.0026）。无意不依从性可由年龄（OR = 0.97，p = 0.0072）、新患者状态（OR = 2.80，p = 0.0239）以及心理无困扰患者在幸福感方面较高的不一致性（p = 0.0504）预测。有意不依从性可由疾病持续时间（OR = 0.55，p = 0.032）、安排随访预约（OR = 0.12，p = 0.0001）、对药物有效性的确定性（OR = 0.99，p = 0.0409）以及患者与医生之间的总体不一致性（OR = 1.59，p = 0.0120）预测。
这些发现表明治疗关系以及个体临床和心理社会特征会影响药物治疗的依从性。
