Center for Outcomes Research, Saint Louis University, St. Louis, MO, USA.
Am J Nephrol. 2011;34(1):71-6. doi: 10.1159/000328391. Epub 2011 Jun 14.
Poor medication adherence is common in end-stage renal disease and may cause suboptimal outcomes and increased healthcare costs. We assessed the association between regimen complexity, perceived burden of oral therapy (BOT) and medication adherence in a large sample of hemodialysis (HD) patients.
1,238 HD patients in 54 Italian centers participated. Data were collected on patients' socio-demographic characteristics, perceived BOT, quality of life, healthcare satisfaction, social support and medication adherence with a self-administered questionnaire. Data on medication regimen, comorbidities, hospitalizations, and transplant listing status were provided by the nursing staff. We estimated the adjusted association of regimen complexity, BOT and medication adherence with logistic regression.
There were 789 (64%) men and the median age was 67 years. Mean daily burden was 9.7 tablets and 48% of patients were adherent to medication prescriptions. The number of tablets prescribed in the medication regimen was associated to adherence likelihood after adjustment for possible confounders. Perceived BOT moderated the association between tablet count and self-reported adherence.
Poor adherence was very common in our sample. Reducing tablet burden might help patients be adherent. However, our results suggest that modulating regimen complexity might be ineffective if patients' negative attitudes toward medications are not addressed concurrently.
终末期肾病患者普遍存在药物治疗依从性差的情况，这可能导致治疗效果不理想和医疗费用增加。我们评估了方案复杂性、口服治疗负担感知（BOT）和药物依从性在大量血液透析（HD）患者中的相关性。
54 家意大利中心的 1238 名 HD 患者参与了研究。使用自我管理问卷收集了患者的社会人口统计学特征、感知 BOT、生活质量、医疗保健满意度、社会支持和药物依从性的数据。护理人员提供了药物治疗方案、合并症、住院和移植登记状态的数据。我们使用逻辑回归估计了方案复杂性、BOT 和药物依从性与药物依从性的调整关联。
研究对象中有 789 名（64%）男性，中位年龄为 67 岁。平均每日负担为 9.7 片，48%的患者依从药物处方。调整了可能的混杂因素后，药物治疗方案中规定的片剂数量与自我报告的依从性之间存在关联。感知 BOT 调节了片剂计数与自我报告的依从性之间的关联。
在我们的样本中，依从性差的情况非常普遍。减少片剂负担可能有助于患者依从治疗。然而，我们的结果表明，如果不同时解决患者对药物的负面态度，调节方案复杂性可能无效。
