Salt Elizabeth, Frazier Susan K
University of Kentucky College of Nursing, Lexington, KY 40536.
Drug Dev Res. 2011 Dec;72(8):756-763. doi: 10.1002/ddr.20484.
Medication adherence is a significant problem in patients with rheumatoid arthritis (RA), a prevalent autoimmune disease. Due to the equivocal results reported in the research, consistent predictors of medication adherence in patients with RA are undetermined. A cross-sectional descriptive, predictive study of 108 patients with RA was used to: 1) describe self-reported medication adherence to disease modifying anti-rheumatic drugs (DMARDs); 2) compare demographic (age, residence, marital status, employment status, years of education, and ethnicity) and clinical (duration of disease and number of medications) factors of adherent and non-adherent individuals; and 3) determine the predictive power of demographic and clinical factors for DMARD adherence using various cut-points (research-based, mean, and median) on a validated, self-report scale measuring medication adherence. Independent samples t-tests, Chi square analyses, and logistic regression modeling were used to analyze these data. Approximately 90% of the individuals with RA reported adherence with their prescribed DMARD prescriptions. The only demographic and clinical difference between the adherent and non-adherent group was ethnicity (p=0.04); nonwhite individuals reported significantly less adherence with their prescribed DMARDs when compared to white individuals. Logistic regression models identified ethnicity (OR= 3.34-10.1; p< 0.05) and the number of medications taken (OR=1.7; p< 0.05) as predictors of medication non-adherence. These data provide evidence that ethnicity and taking an increased number of prescribed medications are independent predictors of medication adherence in patients with RA. These findings confirm the presence of a health disparity and an area where further research is needed to optimize patient outcomes.
药物依从性是类风湿关节炎(RA)患者面临的一个重大问题,类风湿关节炎是一种常见的自身免疫性疾病。由于研究报告的结果不明确,类风湿关节炎患者药物依从性的一致预测因素尚未确定。一项对108例类风湿关节炎患者进行的横断面描述性预测研究旨在:1)描述自我报告的对改善病情抗风湿药物(DMARDs)的药物依从性;2)比较依从和不依从个体的人口统计学因素(年龄、居住地、婚姻状况、就业状况、受教育年限和种族)和临床因素(疾病持续时间和用药数量);3)使用经过验证的自我报告量表,通过各种切点(基于研究的、均值和中位数)来确定人口统计学和临床因素对DMARD依从性的预测能力,该量表用于测量药物依从性。使用独立样本t检验、卡方分析和逻辑回归模型来分析这些数据。大约90%的类风湿关节炎患者报告遵守其规定的DMARD处方。依从组和不依从组之间唯一的人口统计学和临床差异是种族(p=0.04);与白人个体相比,非白人个体报告的对规定DMARDs的依从性明显较低。逻辑回归模型确定种族(OR=3.34-10.1;p<0.05)和用药数量(OR=1.7;p<0.05)是药物不依从的预测因素。这些数据表明,种族和服用更多规定药物是类风湿关节炎患者药物依从性的独立预测因素。这些发现证实了健康差异的存在以及一个需要进一步研究以优化患者治疗效果的领域。