青光眼药物依从性的最常见障碍：一项横断面调查。
The Most Common Barriers to Glaucoma Medication Adherence: A Cross-Sectional Survey.
作者信息
Newman-Casey Paula Anne, Robin Alan L, Blachley Taylor, Farris Karen, Heisler Michele, Resnicow Ken, Lee Paul P
机构信息
Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Department of Ophthalmology & International Health, Johns Hopkins University, Baltimore, Maryland.
出版信息
Ophthalmology. 2015 Jul;122(7):1308-16. doi: 10.1016/j.ophtha.2015.03.026. Epub 2015 Apr 24.
PURPOSE
To evaluate the frequency of 11 commonly cited barriers to optimal glaucoma medication adherence among glaucoma patients and to identify barriers contributing to poor adherence.
DESIGN
Prospective, cross-sectional survey.
PARTICIPANTS
One hundred ninety adults with glaucoma taking 1 or more glaucoma medication who received care in glaucoma clinics in Ann Arbor, Michigan, and Baltimore, Maryland.
METHODS
Participants completed a survey on demographic and disease characteristics, barriers to optimal glaucoma medication adherence, interest in an eye drop aid, and self-reported adherence (measured by the Morisky Adherence Scale). Descriptive statistics and logistic regression analyses were performed.
MAIN OUTCOME MEASURES
Frequency and number of barriers to adherence among both adherent and nonadherent patients. Odds ratios (ORs) with 95% confidence intervals (CIs) identifying barriers associated with poor adherence.
RESULTS
Twenty-seven percent of the sample reported poor adherence. Sixty-one percent of all participants cited multiple barriers and 10% cited a single barrier as impediments to optimal adherence. Twenty-nine percent of subjects cited no barriers, although only 13% of patients who cited no barriers were nonadherent. Among nonadherent patients, 31% or more cited each of the 11 barriers as important. Logistic regression analysis, adjusted for age, revealed that the following barriers were associated with higher odds of nonadherence: decreased self-efficacy (OR, 4.7; 95% CI, 2.2-9.7; P ≤ 0.0001), difficulty instilling drops (OR, 2.3; 95% CI, 1.1-4.9; P = 0.03), forgetfulness (OR, 5.6; 95% CI, 2.6-12.1; P ≤ 0.0001), and difficulties with the medication schedule (OR, 2.9; 95% CI, 1.4-6.0; P = 0.006). For each additional barrier cited as important, there was a 10% increased odds of being nonadherent (OR, 1.1; 95% CI, 1.0-1.2; P = 0.01).
CONCLUSIONS
Each of the 11 barriers was important to at least 30% of surveyed patients with poor adherence, with most identifying multiple barriers to adherence. Low self-efficacy, forgetfulness, and difficulty with drop administration and the medication schedule were barriers associated with poor adherence. Interventions to improve medication adherence must address each patient's unique set of barriers.
目的
评估青光眼患者中11种常见的影响最佳青光眼药物依从性的障碍的出现频率，并确定导致依从性差的障碍。
设计
前瞻性横断面调查。
参与者
190名正在使用1种或更多种青光眼药物的成年青光眼患者，他们在密歇根州安阿伯市和马里兰州巴尔的摩市的青光眼诊所接受治疗。
方法
参与者完成了一项关于人口统计学和疾病特征、最佳青光眼药物依从性的障碍、对滴眼液辅助工具的兴趣以及自我报告的依从性（通过莫利斯基依从性量表测量）的调查。进行了描述性统计和逻辑回归分析。
主要观察指标
依从性好和依从性差的患者中依从性障碍的频率和数量。确定与依从性差相关的障碍的95%置信区间（CI）的比值比（OR）。
结果
27%的样本报告依从性差。61%的所有参与者提到多种障碍，10%提到单一障碍是最佳依从性的阻碍。29%的受试者未提到障碍，尽管在未提到障碍的患者中只有13%是依从性差的。在依从性差的患者中，31%或更多的人将11种障碍中的每一种都视为重要因素。经年龄调整的逻辑回归分析显示，以下障碍与更高的不依从几率相关：自我效能感降低（OR，4.7；95%CI，2.2 - 9.7；P≤0.0001）、滴眼困难（OR，2.3；95%CI，1.1 - 4.
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