Ogedegbe Gbenga, Schoenthaler Antoinette, Fernandez Senaida
Behavioral Cardiovascular Health & Hypertension Program, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA.
J Gen Intern Med. 2007 Aug;22(8):1176-9. doi: 10.1007/s11606-007-0244-y. Epub 2007 Jun 5.
The relationship between appointment-keeping behavior, medication adherence (ADH), and systolic and diastolic blood pressure (SBP and DBP) was assessed in 153 hypertensive African Americans followed in a community-based practice.
ADH was assessed with a self-report questionnaire. BP was obtained from electronic medical records and appointment attendance was determined from the log of all appointments made during the 12-month study period. Nonadherence rates were compared across appointment attendance categories with chi-square. Logistic regression was used to assess the relationship between ADH and appointment attendance, whereas multivariate analysis of covariance (MANCOVA) was used to examine the relationship between appointment attendance and BP.
Twenty-five percent of patients (87% women, mean age 52 years) did not miss any appointments, 44% missed 1-30%, and 31% missed greater than 30%. Adjusted nonadherence rates were similar for all 3 categories (70%, 66%, and 65%, respectively, p = 0.88) as were adjusted mean SBP and DBP in the MANCOVA model, [F (4, 218) = 1.13, p = .34]. Logistic regression analysis did not indicate a significant relationship between appointment attendance and ADH.
Appointment-keeping behavior was not related to ADH or BP among hypertensive African Americans. It should not be used as a proxy for ADH in this patient population.
在一项以社区为基础的实践中,对153名接受随访的非裔美国高血压患者的守约行为、药物依从性(ADH)与收缩压和舒张压(SBP和DBP)之间的关系进行了评估。
通过自我报告问卷评估ADH。从电子病历中获取血压数据,并根据12个月研究期间所有预约记录确定预约就诊情况。采用卡方检验比较不同预约就诊类别的不依从率。使用逻辑回归评估ADH与预约就诊之间的关系,而使用多变量协方差分析(MANCOVA)来检验预约就诊与血压之间的关系。
25%的患者(87%为女性,平均年龄52岁)没有错过任何预约,44%的患者错过1 - 30%,31%的患者错过超过30%。所有3类别的调整后不依从率相似(分别为70%、66%和65%,p = 0.88),MANCOVA模型中的调整后平均SBP和DBP也是如此,[F(4, 218) = 1.13,p = 0.34]。逻辑回归分析未显示预约就诊与ADH之间存在显著关系。
在非裔美国高血压患者中,守约行为与ADH或血压无关。在该患者群体中,不应将其用作ADH的替代指标。