Tran D Q, Barry V, Antun A, Ribeiro M, Stein S, Kempton C L
Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Haemophilia. 2017 Jan;23(1):98-104. doi: 10.1111/hae.13078. Epub 2016 Sep 30.
Poor adherence to factor replacement therapy among patients with haemophilia can lead to joint bleeding and eventual disability.
The aim of this study was to determine patient-related characteristics associated with adherence to factor replacement in adults with haemophilia.
Adults with haemophilia were recruited to participate in this cross-sectional study. Adherence was measured using either the Validated Hemophilia Regimen Treatment Adherence Scale (VERITAS)-Pro or the VERITAS-PRN questionnaire. Simple and multiple regression analyses that controlled for confounding were performed to determine the association between patient-related characteristics and adherence to factor replacement therapy.
Of the 99 subjects enrolled, all were men; 91% had haemophilia A and 78% had severe disease. Age ranged from 18 to 62 years. Most (95%) had functional health literacy; but only 23% were numerate. Mean adherence scores were 45.6 (SD 18) and 51.0 (SD 15) for those on a prophylactic and those on an episodic regimen, respectively, with a lower score indicating better adherence. On multivariable analysis, being on any chronic medication, longer duration followed at our haemophilia treatment centre, higher physician trust and better quality of life were associated with higher adherence. A history of depression was associated with lower adherence.
Two potentially modifiable characteristics, physician trust and depression, were identified as motivator and barrier to adherence to factor replacement therapy. Promoting a high level of trust between the patient and the healthcare team as well as identifying and treating depression may impact adherence to factor replacement therapy and accordingly reduce joint destruction.
血友病患者对凝血因子替代疗法的依从性差会导致关节出血并最终致残。
本研究旨在确定与成年血友病患者凝血因子替代疗法依从性相关的患者相关特征。
招募成年血友病患者参与这项横断面研究。使用经过验证的血友病治疗方案依从性量表（VERITAS）-Pro或VERITAS-PRN问卷来衡量依从性。进行了控制混杂因素的单因素和多因素回归分析，以确定患者相关特征与凝血因子替代疗法依从性之间的关联。
在纳入的99名受试者中，均为男性；91%患有甲型血友病，78%患有严重疾病。年龄在18至62岁之间。大多数（95%）具备功能性健康素养；但只有23%具备数字运算能力。接受预防性治疗和按需治疗方案的患者的平均依从性得分分别为45.6（标准差18）和51.0（标准差15），得分越低表明依从性越好。在多变量分析中，正在服用任何慢性药物、在我们血友病治疗中心的随访时间更长、对医生的信任度更高以及生活质量更好与更高的依从性相关。有抑郁症病史与较低的依从性相关。
确定了两个可能可改变的特征，即对医生的信任和抑郁症，它们分别是凝血因子替代疗法依从性的促进因素和障碍因素。促进患者与医疗团队之间的高度信任以及识别和治疗抑郁症可能会影响凝血因子替代疗法的依从性，从而减少关节破坏。
