Senior Victoria, Marteau Theresa M, Weinman John
Psychology and Genetics Research Group, Guy's Medical School, King's College London, Guy's Campus, London, SE1 9RT, UK.
Cardiovasc Drugs Ther. 2004 Nov;18(6):475-81. doi: 10.1007/s10557-004-6225-z.
The objectives of this study are to describe levels of adherence to cholesterol-lowering medication and to identify predictors of adherence in patients with familial hypercholesterolaemia (FH).
Descriptive questionnaire study.
336 adults patients with FH attending one of five outpatient lipid clinics in South East England underwent a clinical assessment by a nurse and completed a questionnaire. The questionnaire assessed self-reported adherence to cholesterol-lowering medication, anxiety, depression, and patient perceptions of heart disease.
Overall, participants reported high levels of medication adherence, although 63% reported some level of non-adherence. Total medication adherence (never deviating from the regimen) was more likely to be reported by older participants, those with no formal educational qualifications, those with a personal history of cardiovascular disease, those with a lower total cholesterol level, and those with a greater difference between untreated cholesterol levels and current cholesterol levels. The illness perceptions associated with reported total adherence were lower perceived risk of raised cholesterol, perceiving greater control over FH, and perceiving genes and cholesterol to be important determinants of a heart attack. Emotional state was not associated with medication adherence. In logistic regression analysis, predictors of total medication adherence were having personal history of cardiovascular disease, having no formal qualifications, and perceiving genes to be important determinants of a heart attack.
Both clinical factors and patients' illness perceptions were associated with self-reported cholesterol-lowering medication adherence. The association with illness perceptions was small and many of these associations may be a consequence, rather than a cause, of greater adherence. Given this, intervention strategies aimed at helping patients' to establish routines for medication taking may be more effective in increasing adherence than interventions designed to alter perceptions related to taking statins.
本研究的目的是描述家族性高胆固醇血症（FH）患者对降胆固醇药物的依从水平，并确定依从性的预测因素。
描述性问卷调查研究。
在英格兰东南部五家门诊脂质诊所之一就诊的336名成年FH患者接受了护士的临床评估，并完成了一份问卷。该问卷评估了自我报告的降胆固醇药物依从性、焦虑、抑郁以及患者对心脏病的看法。
总体而言，参与者报告的药物依从性较高，尽管63%的人报告有一定程度的不依从。年龄较大的参与者、没有正规学历的人、有心血管疾病个人史的人、总胆固醇水平较低的人以及未治疗胆固醇水平与当前胆固醇水平差异较大的人更有可能报告完全依从药物治疗方案（从不偏离治疗方案）。与报告的完全依从相关的疾病认知包括较低的胆固醇升高风险感知、对FH有更大的控制感以及认为基因和胆固醇是心脏病的重要决定因素。情绪状态与药物依从性无关。在逻辑回归分析中，完全药物依从性的预测因素是有心血管疾病个人史、没有正规学历以及认为基因是心脏病的重要决定因素。
临床因素和患者的疾病认知均与自我报告的降胆固醇药物依从性相关。与疾病认知的关联较小，而且其中许多关联可能是依从性更高的结果而非原因。鉴于此，旨在帮助患者建立服药常规的干预策略可能比旨在改变与服用他汀类药物相关认知的干预措施在提高依从性方面更有效。
