Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, Sanuki, Japan.
J Clin Pharm Ther. 2014 Feb;39(1):45-52. doi: 10.1111/jcpt.12100. Epub 2013 Sep 25.
Patients' poor adherence to medications is reported to be related to the individual patients' beliefs and cognitions and their trust of the medical staff. However, the causes of the two forms of non-adherence, intentional and unintentional behaviours, have yet to be clarified. This study compared psychological latent factors associated with intentional and unintentional non-adherence to chronic medication regimens, focusing on the potential effects of (i) patients' dissatisfaction with treatment and their relationships with the medical staff and (ii) patients' subliminal rational thinking processes, which weighed the positive values such as their expectations of benefits from treatment against negative values such as their dissatisfaction.
Two cross-sectional surveys were undertaken of patients given medications for chronic diseases, using a questionnaire developed and validated in this study. One survey was undertaken in three hospitals and the other survey, online throughout Japan. We scored the individual latent factors using the questionnaire and calculated the differential score between two negatively correlated latent factors to quantify patients' subliminal rational thinking process. We compared the adjusted odds ratio (OR) of latent factors between intentional and unintentional non-adherence to medication in both surveys.
Of the eligible subjects, 149 hospitalized patients and 524 survey participants completed the questionnaire. Intentional non-adherence was associated with patient dissatisfaction with treatment including interpersonal relationships with medical staff in both hospitalized patients and online survey participants (95% confidence interval of adjusted OR for Dissatisfaction, 1·20-16·26 in the hospital-based survey and 1·33-3·45 in the online survey). In both surveys, intentional non-adherence was significantly associated with the differential score between two negatively correlated latent factors, Willingness and Dissatisfaction (P = 0·02 in the hospital-based survey and P < 0·001 in the online survey). However, these associations were not evident in unintentionally non-adherent patients.
Patients' dissatisfaction and their resulting rational judgments are unique, consistent determinants of intentional non-adherence to medications, but not of unintentional non-adherence.
据报道，患者对药物的依从性差与患者的个人信念和认知以及他们对医务人员的信任有关。然而，两种形式的不依从，即故意和非故意行为的原因仍未阐明。本研究比较了与慢性药物治疗方案的故意和非故意不依从相关的心理潜在因素，重点关注（i）患者对治疗的不满及其与医务人员的关系，以及（ii）患者潜意识理性思维过程的潜在影响，该过程权衡了治疗益处的积极价值（如他们的期望）与消极价值（如他们的不满）。
使用本研究中开发和验证的问卷，对接受慢性病药物治疗的患者进行了两项横断面调查。一项调查在三家医院进行，另一项调查在日本各地进行在线调查。我们使用问卷对各个潜在因素进行评分，并计算两个负相关潜在因素之间的差异评分，以量化患者的潜意识理性思维过程。我们比较了两项调查中药物治疗的故意和非故意不依从的潜在因素的调整比值比（OR）。
在合格的受试者中，149 名住院患者和 524 名调查参与者完成了问卷。在住院患者和在线调查参与者中，故意不依从与患者对治疗的不满有关，包括与医务人员的人际关系（在医院为基础的调查中调整后的 OR 的 95%置信区间为不满 1.20-16.26，在线调查中为 1.33-3.45）。在两项调查中，故意不依从与两个负相关潜在因素之间的差异评分显著相关，即意愿和不满（在医院为基础的调查中 P=0.02，在线调查中 P<0.001）。然而，这些关联在非故意不依从的患者中并不明显。
患者的不满及其由此产生的理性判断是故意不依从药物治疗的独特且一致的决定因素，但不是非故意不依从的决定因素。
