Wouters Hans, Van Dijk Liset, Geers Harm C J, Winters Nina A, Van Geffen Erica C G, Stiggelbout Anne M, Bouvy Marcel L
Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands.
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
PLoS One. 2016 Jan 25;11(1):e0146272. doi: 10.1371/journal.pone.0146272. eCollection 2016.
Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences.
To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations.
Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data.
Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13-2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17-3.08, P < 0.01). Higher 'perceived self-efficacy' did not moderate these associations.
Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient alliance.
他汀类药物的不依从性很严重，且与多种认知和经历有关。然而，临床实践中的时间限制阻碍了对这些认知和经历的深入探究。
提出并检验一种策略，旨在有效评估关于他汀类药物疗效、副作用及实际问题的多种认知和经历。此外，评估这一系列经历和认知与不依从性之间的关联，并检验患者的“感知自我效能感”是否调节了这些关联。
通过社区药房招募患者。使用电子定制药物清单有效评估患者的多种特定认知和经历，该清单允许人们跳过无关问题。通过自我报告和药房配药数据测量依从性。
在参与研究的229名患者中（平均年龄63.9岁，标准差10.2），40%-70%的患者怀疑他汀类药物的必要性或对其疗效缺乏了解，20%-35%的患者担心关节和肌肉副作用或有过此类经历，23%的患者在他汀类药物信息、片剂服用、包装或泡罩方面遇到过实际问题。遇到更多实际问题与无意不依从性增加相关（比值比1.54，95%置信区间：1.13-2.10，P<0.01），而担心副作用与有意不依从性增加相关（比值比1.90，95%置信区间：1.17-3.08，P<0.01）。较高的“感知自我效能感”并未调节这些关联。
深入了解患者在合理使用他汀类药物方面面临的具体障碍，可能揭示不依从的个人原因。定制药物清单是一种很有前景的工具，可用于制定个性化干预策略，旨在通过医患联盟提高依从性。
