Unidad de Sistemas de Información, SERMAS, Madrid, Spain.
Drugs Aging. 2010 Aug 1;27(8):641-51. doi: 10.2165/11537320-000000000-00000.
Adherence to the therapeutic plan is one of the most important health issues in terms of treatment efficacy, healthcare costs and patient safety. Unfortunately, homebound elderly patients are especially vulnerable to nonadherence because they have higher morbidity rates combined with cognitive and social problems that hinder their correct use of drugs. The level of therapeutic adherence in homebound elderly people has not been adequately studied.
To estimate the prevalence of therapeutic adherence, using the Morisky-Green test, in homebound elderly patients taking polypharmacy (defined as use of four or more drugs), and to study the factors associated with adherence.
This was a descriptive, cross-sectional, multicentre study. A total of 327 patients were selected by random start systematic sampling from the total number of homebound patients taking four or more drugs in Healthcare Area 4 of the Madrid Autonomous Region, Spain. Through an in-home survey of patients and their caregivers, information was gathered on sociodemographic data, co-morbidities, number of hospital admissions, responsibility for purchasing and preparation of the medication, level of cognitive impairment (Pfeiffer questionnaire), functional dependence in activities of daily living (Katz Index), knowledge of the disease (Batalla test), adherence to treatment (Morisky-Green test), visual and auditory perception, and caregiver burden (Zarit interview).
Of the homebound patients, 65.7% (95% CI 60.6, 70.9) had good adherence to treatment. The variables most negatively associated with therapeutic adherence, after adjustment for age, sex, number of drugs, knowledge of the disease, and cognitive function, were a large caregiver burden (odds ratio [OR] 3.09; 95% CI 1.75, 5.48) and impaired hearing (OR 2.00; 95% CI 1.17, 3.40). There was also a trend toward a positive association between nonadherence and patients aged <85 years (OR 1.57; 95% CI 0.93, 2.65) and patients who had nine or more drug prescriptions (OR 1.59; 95% CI 0.96, 2.65).
Poor therapeutic adherence in homebound elderly patients receiving polypharmacy is a serious problem affecting one of every three individuals concerned, and is directly related to caregiver burden, regardless of age, sex, cognitive status or number of drugs administered.
在治疗效果、医疗成本和患者安全方面，治疗方案的依从性是最重要的健康问题之一。不幸的是，居家的老年患者特别容易出现不依从，因为他们的发病率较高，加上认知和社会问题，阻碍了他们正确使用药物。居家老年患者的治疗依从性水平尚未得到充分研究。
使用 Morisky-Green 测试评估服用多种药物（定义为使用四种或更多种药物）的居家老年患者的治疗依从性，研究与依从性相关的因素。
这是一项描述性、横断面、多中心研究。通过随机起点系统抽样，从西班牙马德里自治区医疗保健区 4 中服用四种或更多种药物的所有居家患者中，共选择了 327 名患者。通过对患者及其护理人员进行家访，收集了社会人口统计学数据、合并症、住院次数、购买和准备药物的责任、认知障碍程度（Pfeiffer 问卷）、日常生活活动功能依赖（Katz 指数）、疾病知识（Batalla 测试）、治疗依从性（Morisky-Green 测试）、视觉和听觉感知以及护理人员负担（Zarit 访谈）。
在居家患者中，65.7%（95%可信区间 60.6%，70.9%）治疗依从性良好。调整年龄、性别、药物数量、疾病知识和认知功能后，与治疗依从性最负相关的变量是护理人员负担大（比值比[OR]3.09；95%可信区间 1.75，5.48）和听力受损（OR 2.00；95%可信区间 1.17，3.40）。治疗不依从与年龄<85 岁的患者（OR 1.57；95%可信区间 0.93，2.65）和接受 9 种或更多药物处方的患者（OR 1.59；95%可信区间 0.96，2.65）之间也存在正向趋势。
服用多种药物的居家老年患者治疗依从性差是一个严重问题，每 3 名患者中就有 1 名受到影响，且与护理人员负担直接相关，与年龄、性别、认知状况或用药数量无关。
