Krauskopf Katherine, Federman Alex D, Kale Minal S, Sigel Keith M, Martynenko Melissa, O'Conor Rachel, Wolf Michael S, Leventhal Howard, Wisnivesky Juan P
1Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York, NY , USA.
COPD. 2015 Apr;12(2):151-64. doi: 10.3109/15412555.2014.922067. Epub 2014 Jun 24.
Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self-Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohort of English- and Spanish-speaking adults with COPD from New York and Chicago. Medication adherence was assessed using the Medication Adherence Report Scale. Illness and medication beliefs along CSM domains were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen's d effect sizes) and multiple logistic regression were used to assess the relationship between illness and medication beliefs with adherence. The study included 188 participants (47% Black, 13% Hispanics); 109 (58%) were non-adherent. Non-adherent participants were younger (p < 0.001), more likely to be Black or Hispanic (p = 0.001), to have reported low income (p = 0.02), and had fewer years of formal education (p = 0.002). In unadjusted comparisons, non-adherent participants reported being more concerned about their COPD (p = 0.011; Cohen's d = 0.43), more emotionally affected by the disease (p = 0.001; Cohen's d = 0.54), and had greater concerns about COPD medications (p < 0.001, Cohen's d = 0.81). In adjusted analyses, concerns about COPD medications independently predicted non-adherence (odds ratio: 0.52, 95% confidence interval: 0.36-0.75). In this cohort of urban minority adults, concerns about medications were associated with non-adherence. Future work should explore interventions to influence patient adherence by addressing concerns about the safety profile and long-term effects of COPD medications.
慢性阻塞性肺疾病（COPD）患者中近一半不坚持服药。疾病和用药观念是其他慢性病患者服药依从性的重要决定因素。我们运用自我调节常识模型（CSM）框架，在一组来自纽约和芝加哥、讲英语和西班牙语的成年COPD患者中，确定了潜在可改变的观念与COPD药物依从性之间的关联。使用药物依从性报告量表评估药物依从性。运用简短疾病认知问卷（B - IPQ）和药物信念问卷（BMQ）评估CSM各领域的疾病和用药观念。采用未调整分析（效应量为Cohen's d）和多元逻辑回归来评估疾病和用药观念与依从性之间的关系。该研究纳入了188名参与者（47%为黑人，13%为西班牙裔）；109名（58%）未坚持服药。未坚持服药的参与者更年轻（p < 0.001），更可能是黑人或西班牙裔（p = 0.001），报告低收入的可能性更大（p = 0.02），接受正规教育的年限更少（p = 0.002）。在未调整的比较中，未坚持服药的参与者报告更担心自己的COPD（p = 0.011；Cohen's d = 0.43），受疾病的情绪影响更大（p = 0.001；Cohen's d = 0.54），对COPD药物的担忧也更多（p < 0.001，Cohen's d = 0.81）。在调整分析中，对COPD药物的担忧独立预测了不依从性（比值比：0.52，95%置信区间：0.36 - 0.75）。在这组城市少数族裔成年人中，对药物的担忧与不依从性相关。未来的工作应探索通过解决对COPD药物安全性和长期影响的担忧来影响患者依从性的干预措施。
