在临床实践中，能否诊断 COPD 患者的治疗依从性？一项队列研究。
Is it possible to diagnose the therapeutic adherence of patients with COPD in clinical practice? A cohort study.
机构信息
Family and Community Medicine Teaching Unit of Malaga, Health District Malaga, Málaga, Spain.
出版信息
BMC Pulm Med. 2011 Jan 24;11:6. doi: 10.1186/1471-2466-11-6.
BACKGROUND
Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. It is therefore necessary to determine the magnitude of non-adherence to develop strategies to correct this behaviour. The purpose of this study was to analyse the diagnostic validity of indirect adherence methods.
SAMPLE
195 COPD patients undergoing scheduled inhaled treatment attending 5 Primary Care Centres of Malaga, Spain.
VARIABLES
Sociodemographic profile, illness data, spirometry, quality of life (St. George Respiratory Questionnaire: SGRQ), and inhaled medication counting (count of dose/pill or electronic monitoring) were collected. The patient's knowledge of COPD (Batalla test:BT),their attitude towards treatment (Morisky-Green test: MGT) and their self-reported therapeutic adherence (Haynes-Sackett test: HST) were used as methods of evaluating adherence. The follow-up consisted four visits over one year (the recruitment visit: V0; and after 1 month:V1; 6 months:V2; and 1 year:V3).
RESULTS
The mean age was 69.59 (95% CI, 68.29-70.89) years old and 93.8% were male. Other findings included: 85.4% had a low educational level, 23.6% were smokers, 71.5% mild-moderate COPD stage with a FEV1 = 56.86 (SD = 18.85); exacerbations per year = 1.41(95% CI, 1-1.8). The total SGRQ score was 44.96 (95% CI, 42.46-47.46), showing a mild self-perceived impairment in health. The prevalence of adherence (dose/pill count) was 68.1% (95% CI, 60.9-75.3) at V1, 80% (95% CI, 73-87) at V2 and 84% (95% CI, 77.9) at V3. The MGT showed a specificity of 67.34% at V1, 76.19% at V2 and 69.62% at V3. The sensitivity was 53.33% at V1, 66.66% at V2 and 33.33% at V3.The BT showed a specificity of 55.1% at V1, 70.23% at V2 and 67.09% at V3. The sensitivity was 68.88% at V1, 71.43% at V2 and 46.66% at V3. Considering both tests together, the specificity was 86.73% at V1, 94.04% at V2 and 92.49% at V3 and the sensitivity was 37.77% at V1, 47.62% at V2 and 13.3% at V3.
CONCLUSIONS
The prevalence of treatment adherence changes over time. Indirect methods (dose/pill count and self-reported) can be useful to detect non-adherence in COPD patients. The combination of MGT and BT is the best approach to test self-reported adherence.
背景
慢性阻塞性肺疾病（COPD）患者的治疗依从性较差。因此，有必要确定不依从的程度，以制定纠正这种行为的策略。本研究的目的是分析间接依从方法的诊断准确性。
样本
195 名在西班牙马拉加的 5 个初级保健中心接受计划吸入治疗的 COPD 患者。
变量
收集了社会人口统计学特征、疾病数据、肺活量测定、生活质量（圣乔治呼吸问卷：SGRQ）和吸入药物计数（剂量/药丸计数或电子监测）。使用患者对 COPD 的了解（巴塔拉测试：BT）、他们对治疗的态度（莫里斯基-格林测试：MGT）和他们自我报告的治疗依从性（海恩斯-塞克特测试：HST）作为评估依从性的方法。随访包括一年中的四次就诊（招募就诊：V0；以及 1 个月后：V1；6 个月后：V2；和 1 年后：V3）。
结果
平均年龄为 69.59 岁（95%置信区间，68.29-70.89），93.8%为男性。其他发现包括：85.4%的人文化程度较低，23.6%为吸烟者，71.5%为轻度至中度 COPD 期，FEV1 = 56.86（SD = 18.85）；每年的恶化次数= 1.41（95%置信区间，1-1.8）。总 SGRQ 评分为 44.96（95%置信区间，42.46-47.46），表明自我感知健康轻度受损。（剂量/药丸计数）的依从率在 V1 时为 68.1%（95%置信区间，60.9-75.3），在 V2 时为 80%（95%置信区间，73-87），在 V3 时为 84%（95%置信区间，77.9）。MGT 在 V1 时的特异性为 67.34%，在 V2 时为 76.19%，在 V3 时为 69.62%。灵敏度在 V1 时为 53.33%，在 V2 时为 66.66%，在 V3 时为 33.33%。BT 在 V1 时的特异性为 55.1%，在 V2 时为 70.23%，在 V3 时为 67.09%。灵敏度在 V1 时为 68.88%，在 V2 时为 71.43%，在 V3 时为 46.66%。考虑到两个测试一起，特异性在 V1 时为 86.73%，在 V2 时为 94.04%，在 V3 时为 92.49%，灵敏度在 V1 时为 37.77%，在 V2 时为 47.62%，在 V3 时为 13.3%。
结论
治疗依从性随时间而变化。间接方法（剂量/药丸计数和自我报告）可用于检测 COPD 患者的不依从性。MGT 和 BT 的组合是测试自我报告依从性的最佳方法。
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