Ghimire Saurav, Peterson Gregory M, Castelino Ronald L, Jose Matthew D, Zaidi Syed Tabish R
Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, University of Tasmania, Hobart, Australia.
Am J Nephrol. 2016;43(5):318-24. doi: 10.1159/000446450. Epub 2016 May 11.
The impact of medication regimen complexity on adherence in hemodialysis patients is unknown. We investigated regimen complexity, perceived burden of medicines (PBM) and health-related quality of life (HR-QoL) as potential predictors of adherence.
Adult (≥18 years) hemodialysis patients were included. Data on medication regimen complexity index (MRCI), self-reported and objective adherence, comorbidity index, PBM and HR-QoL were obtained using established measures. Sociodemographic and clinical characteristics were collected during interviews and by reviewing medical records. Predictors of adherence were determined using logistic regression.
Fifty-three out of 70 hemodialysis patients participated (response rate 75%; male 58.5%; age 67.9 ± 11.5 years). The mean MRCI, HR-QoL and PBM scores were 27.0 ± 10.9, 0.70 ± 0.13 and 1.7 ± 0.6, respectively. Based on self-reports, 43.4% (n = 23) were adherent, whereas for a subset of patients analyzed using objective measure (n = 33), much lower adherence rate was observed (27.3%, n = 9). The self-reported and objective measures were significantly correlated (r = 0.43, p = 0.01). Older age was the only significant predictor of self-reported adherence (OR 1.05; 95% CI 1.00-1.11) whereas older age (OR 1.10; 95% CI 1.00-1.21), higher comorbidity (OR 1.58; 95% CI 1.03-2.42) and MRCI (OR 1.14; 95% CI 1.02-1.27) were independent predictors of objective adherence.
The findings of this exploratory study suggest that older patients with high comorbidities and highly complex regimen are more likely to be adherent based on an objective measure. Future research is needed using objective measures of adherence suitable for all patients and reflecting all medications.
药物治疗方案的复杂性对血液透析患者依从性的影响尚不清楚。我们调查了治疗方案复杂性、感知药物负担（PBM）和健康相关生活质量（HR-QoL）作为依从性的潜在预测因素。
纳入成年（≥18岁）血液透析患者。使用既定方法获取关于药物治疗方案复杂性指数（MRCI）、自我报告和客观依从性、合并症指数、PBM和HR-QoL的数据。在访谈期间并通过查阅病历收集社会人口学和临床特征。使用逻辑回归确定依从性的预测因素。
70名血液透析患者中有53名参与（应答率75%；男性58.5%；年龄67.9±11.5岁）。平均MRCI、HR-QoL和PBM评分分别为27.0±10.9、0.70±0.13和1.7±0.6。根据自我报告，43.4%（n = 23）的患者依从，而对于使用客观测量方法分析的一部分患者（n = 33），观察到的依从率要低得多（27.3%，n = 9）。自我报告和客观测量方法显著相关（r = 0.43，p = 0.01）。年龄较大是自我报告依从性的唯一显著预测因素（OR 1.05；95% CI 1.00 - 1.11），而年龄较大（OR 1.10；95% CI 1.00 - 1.21）、较高的合并症（OR 1.58；95% CI 1.03 - 2.42）和MRCI（OR 1.14；95% CI 1.02 - 1.27）是客观依从性的独立预测因素。
这项探索性研究的结果表明，根据客观测量方法，合并症高且治疗方案高度复杂的老年患者更有可能依从。需要开展进一步研究，使用适用于所有患者并反映所有药物的客观依从性测量方法。
