Leiden University Medical Centre, The Netherlands.
Arthritis Care Res (Hoboken). 2011 Mar;63(3):342-50. doi: 10.1002/acr.20411. Epub 2010 Nov 30.
Patients may be defined as nonadherent if they do not take their medications as prescribed by their physicians. Determinants of nonadherence may vary between and within patient groups. This study investigated the extent to which patients with systemic lupus erythematosus (SLE) show intentional and unintentional nonadherence, and the associations of nonadherence with psychological and medical parameters.
The study included 106 patients who were receiving at least one immunosuppressive agent to control their SLE. Level of self-reported adherence and a measure of both intentional and unintentional nonadherence were obtained. Questionnaires were completed to assess associations between adherence and problems with cognitive functioning, beliefs about medicines, illness perceptions, emotional health, and disease characteristics.
The mean self-reported adherence rate for the total patient group was 86.7%. At least occasional intentional nonadherence was reported by 46.2% of patients and 58.5% of patients were at least occasionally unintentionally nonadherent. Problems with cognitive functioning, concerns about adverse effects of medication, and younger age were the strongest predictors of (non)adherence. Patients who were emotionally affected by their SLE were more likely to report low adherence, but this was not a significant predictor after accounting for other variables. Disease characteristics showed no relationship to measures of adherence.
Although SLE patients reported high levels of adherence on average, they commonly reported intentional and unintentional nonadherence. Adherence was associated with both cognitions and emotions. Nonadherence may be reduced by targeting emotional and cognitive functioning and by fine tuning doctor-patient communication to address patients' individual concerns about their medications.
如果患者未按照医生的规定服用药物，则可将其定义为不依从。不依从的决定因素可能在患者群体之间和内部有所不同。本研究调查了系统性红斑狼疮（SLE）患者表现出有意和无意不依从的程度，以及不依从与心理和医学参数的关联。
本研究纳入了 106 名正在接受至少一种免疫抑制剂治疗以控制其 SLE 的患者。获得了自我报告的依从水平以及有意和无意不依从的衡量标准。完成了调查问卷，以评估依从性与认知功能障碍、对药物的信念、疾病认知、情绪健康和疾病特征之间的关系。
总体患者组的平均自我报告依从率为 86.7%。至少偶尔有意不依从的患者占 46.2%，至少偶尔无意不依从的患者占 58.5%。认知功能障碍问题、对药物不良反应的担忧以及年龄较小是（不）依从的最强预测因素。受 SLE 情绪影响的患者更有可能报告低依从性，但在考虑其他变量后，这并不是一个显著的预测因素。疾病特征与依从性衡量标准之间没有关系。
尽管 SLE 患者平均报告的依从水平较高，但他们经常报告有意和无意的不依从。依从性与认知和情绪都有关。通过针对情绪和认知功能，并通过微调医患沟通以解决患者对其药物的个体关注，可以减少不依从。
