Moreira Leonardo B, Fernandes Paula F C B C, Mota Rosa S, Monte Francisca S, Galvão Rita I M, Sousa Daniel F, Martins Alice M C
Federal University of Ceará, Fortaleza City, Ceará State, Brazil.
J Nephrol. 2008 May-Jun;21(3):354-62.
Medication noncompliance has a harmful impact on reaching therapeutic goals of delaying the progression of chronic kidney disease (CKD). The aim of the present study is to calculate the prevalence of medication noncompliance and to identify medication noncompliance-associated factors in CKD.
A cross-sectional study was performed with 130 CKD patients from a university nephrology outpatient clinic, mean age 48.8 +/- 15.8 years, who were continuously self-administering an antihypertensive or immunosuppressive drug, and who were neither on dialysis nor had received a kidney transplant. Noncompliance was measured through self-report (during an interview) and physician assessment. Patients were considered noncompliers if noncompliance had been detected by any of these methods. Sociodemographic, clinical and laboratory and medication characteristics were surveyed, as well as patients' knowledge regarding prescribed medicines and opinions of the quality of the health care service provided.
Prevalence of medication noncompliance was 36.9% (95% confidence interval [95% CI], 28.6%-45.8%). Lack of access to medicines was the most commonly reported problem with medication use (62.5%). Multiple logistic regression analysis showed that patients' insufficient knowledge regarding prescribed medicines (p=0.040) and bad opinions of the quality of the provided health care service (p=0.027) were independently associated with noncompliance.
Medication noncompliance prevalence was high among the patients studied. Lack of access to medicines remains an important public health problem. The noncompliance-associated factors identified in CKD were the patients' poor knowledge regarding the pharmacotherapy and dissatisfaction with the health care service provided.
药物治疗不依从对实现延缓慢性肾脏病（CKD）进展的治疗目标具有有害影响。本研究的目的是计算药物治疗不依从的患病率，并确定CKD中与药物治疗不依从相关的因素。
对来自大学肾脏病门诊的130例CKD患者进行了一项横断面研究，这些患者平均年龄为48.8±15.8岁，正在持续自行服用抗高血压或免疫抑制药物，且未接受透析治疗或肾移植。通过自我报告（在访谈期间）和医生评估来衡量不依从情况。如果通过任何一种方法检测到不依从，则将患者视为不依从者。调查了社会人口统计学、临床、实验室和药物特征，以及患者对处方药的了解情况和对所提供医疗服务质量的看法。
药物治疗不依从的患病率为36.9%（95%置信区间[95%CI]，28.6%-45.8%）。药物使用方面最常报告的问题是无法获得药物（62.5%）。多因素逻辑回归分析表明，患者对处方药的了解不足（p=0.040）和对所提供医疗服务质量的负面评价（p=0.027）与不依从独立相关。
在所研究的患者中，药物治疗不依从的患病率较高。无法获得药物仍然是一个重要的公共卫生问题。在CKD中确定的与不依从相关的因素是患者对药物治疗的了解不足以及对所提供医疗服务的不满。
