Medical Information Department, University Hospital of Besançon, Besançon, France.
PLoS One. 2012;7(3):e32412. doi: 10.1371/journal.pone.0032412. Epub 2012 Mar 5.
Adherence to prescribed medications is a key dimension of healthcare quality. The aim of this large population-based study was to evaluate self-reported medication adherence and to identify factors linked with poor adherence in patients with type 2 diabetes in France.
The ENTRED study 2007, a French national survey of people treated for diabetes, was based on a representative sample of patients who claimed reimbursement for oral hypoglycaemic agents and/or insulin at least three times between August 2006 and July 2007, and who were randomly selected from the database of the two main National Health Insurance Systems. Medication adherence was determined using a six-item self-administered questionnaire. A multinomial polychotomous logistic regression model was used to identify factors associated with medication adherence in the 3,637 persons with type 2 diabetes.
Thirty nine percent of patients reported good medication adherence, 49% medium adherence and 12% poor adherence. The factors significantly associated with poor adherence in multivariate analysis were socio-demographic factors: age <45 years, non-European geographical origin, financial difficulties and being professionally active; disease and therapy-related factors: HbA(1c)>8% and existing diabetes complications; and health care-related factors: difficulties for taking medication alone, decision making by the patient only, poor acceptability of medical recommendations, lack of family or social support, need for information on treatment, reporting no confidence in the future, need for medical support and follow-up by a specialist physician.
In a country with a high level of access to healthcare, our study demonstrated a substantial low level of medication adherence in type 2 diabetic patients. Better identification of those with poor adherence and individualised suitable recommendations remain essential for better healthcare management.
遵医嘱服药是医疗质量的一个关键维度。本项基于大量人群的研究旨在评估 2 型糖尿病患者的自我报告服药依从性，并确定与服药依从性差相关的因素。
ENTRED 研究 2007 年是一项针对法国糖尿病患者的全国性调查，该研究基于一个具有代表性的治疗组患者样本，这些患者在 2006 年 8 月至 2007 年 7 月期间至少三次因口服降糖药和/或胰岛素报销而就诊，且他们是从两大国家健康保险系统数据库中随机抽取的。用药依从性采用 6 项自评问卷来确定。采用多变量多项式逻辑回归模型来确定与 3637 例 2 型糖尿病患者服药依从性相关的因素。
39%的患者报告服药依从性良好，49%的患者报告中等依从性，12%的患者报告较差依从性。多变量分析中与较差依从性显著相关的因素包括社会人口学因素：年龄<45 岁，非欧洲原籍，经济困难和有职业活动；疾病和治疗相关因素：HbA1c>8%和存在糖尿病并发症；以及卫生保健相关因素：独自服药困难，仅由患者做出决策，对医学建议的接受程度差，缺乏家庭或社会支持，需要治疗信息，对未来缺乏信心，需要医疗支持和专科医生的随访。
在一个医疗服务高度可及的国家，我们的研究表明 2 型糖尿病患者的服药依从性水平较低。更好地识别出依从性差的患者并为其提供个体化的合适建议，对于改善医疗保健管理仍然至关重要。
