Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, David M. Rubenstein Building, 200 North Wolfe Street, Baltimore, Maryland 21287, USA.
Pediatr Pulmonol. 2012 Mar;47(3):283-91. doi: 10.1002/ppul.21547. Epub 2011 Sep 8.
Chronic lung disease of prematurity (CLDP) is a frequent complication of premature birth. Infants and children with CLDP are often prescribed complex medication regimens, which can be difficult for families to manage.
We sought to determine whether non-adherence was associated with increased CLDP-related morbidities and to identify predictors of adherence.
Recruited caregivers of 194 children with CLDP completed questionnaires regarding self-reported adherence, respiratory outcomes, and quality of life (January 2008-June 2010). Adherence data were available for 176 subjects, of whom 143 had self-reported data only, and 33 had prescription claims data, which were used to calculate a medication possession ratio (MPR). Participants in the Prescription Claims Sample (n = 33) were more likely to have public insurance (P < 0.001).
Self-reported adherence substantially overestimated medication possession; the mean MPR was 38.8% (n = 33) and was not associated with self-reported adherence (P = 0.71; n = 26). In a small sample, higher MPR was associated with decreased odds ratios of visiting the emergency department (ED) (OR = 0.75 for a 10% increase in MPR [95%CI: 0.58, 0.97]; P = 0.03; n = 74 questionnaires from 28 participants), activity limitations (OR = 0.71 [95%CI: 0.53, 0.95]; P = 0.02; n = 70 questionnaires from 28 participants), and rescue medication use (OR = 0.84 [95%CI: 0.73-0.98]; P = 0.03; n = 70 questionnaires from 28 participants). Increasing caregiver worries regarding medication efficacy and side effects were associated with lower MPR (P = 0.04 and 0.02, respectively; n = 62 questionnaires from 27 participants). Socio-demographic and clinical risk factors were not predictors of MPR (n = 33).
We found that non-adherence with respiratory medications was common in premature infants and children with CLDP. Using multiple timepoints in a small sample, non-adherence was associated with a higher likelihood of respiratory morbidities. Although self-reported adherence and demographic characteristics did not predict MPR, concerns about medications did. We suggest that addressing caregiver concerns about medications may improve adherence and ultimately decrease CLDP-related morbidities. Larger, prospective studies are needed to confirm these findings and determine which factors predict non-adherence.
早产儿慢性肺病（CLDP）是早产儿常见的并发症。患有 CLDP 的婴儿和儿童经常需要服用复杂的药物治疗方案，这对家庭来说很难管理。
我们旨在确定不依从是否与 CLDP 相关的发病率增加有关，并确定依从性的预测因素。
招募了 194 名患有 CLDP 的儿童的照顾者，他们完成了关于自我报告的依从性、呼吸结局和生活质量的问卷（2008 年 1 月至 2010 年 6 月）。176 名受试者有依从性数据，其中 143 名仅有自我报告数据，33 名有处方索赔数据，用于计算药物持有率（MPR）。在处方索赔样本中（n=33），有更多的人拥有公共保险（P<0.001）。
自我报告的依从性大大高估了药物的持有量；平均 MPR 为 38.8%（n=33），与自我报告的依从性无关（P=0.71；n=26）。在一个小样本中，较高的 MPR 与急诊就诊的几率降低相关（MPR 增加 10%，比值比为 0.75[95%CI：0.58，0.97]；P=0.03；n=28 名参与者的 74 份问卷），活动受限（比值比为 0.71[95%CI：0.53，0.95]；P=0.02；n=28 名参与者的 70 份问卷）和使用抢救药物（比值比为 0.84[95%CI：0.73-0.98]；P=0.03；n=28 名参与者的 70 份问卷）。照顾者对药物疗效和副作用的担忧增加与 MPR 降低有关（P=0.04 和 0.02；n=27 名参与者的 62 份问卷）。社会人口统计学和临床危险因素不是 MPR 的预测因素（n=33）。
我们发现，早产儿和患有 CLDP 的儿童中，对呼吸药物的不依从很常见。在一个小样本中使用多个时间点，不依从与更高的呼吸发病率有关。尽管自我报告的依从性和人口统计学特征不能预测 MPR，但对药物的担忧可以。我们建议解决照顾者对药物的担忧可能会提高依从性，并最终降低 CLDP 相关的发病率。需要更大规模的前瞻性研究来证实这些发现，并确定哪些因素预测不依从。
