药物不良事件和治疗满意度对高血压患者用药依从性的影响——一项门诊患者研究。
Impact of adverse drug events and treatment satisfaction on patient adherence with antihypertensive medication - a study in ambulatory patients.
机构信息
Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, The Netherlands.
Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
出版信息
Br J Clin Pharmacol. 2017 Sep;83(9):2107-2117. doi: 10.1111/bcp.13312. Epub 2017 Jun 15.
AIMS
The aim of the present study was to evaluate the impact of adverse drug events (ADEs) and treatment satisfaction on antihypertensive medication adherence.
METHODS
A cross-sectional study was conducted in six public hospitals in Ethiopia. We included adult ambulatory patients on antihypertensive medication. Adherence was measured using the eight-point Morisky Medication Adherence Scale, which categorizes as low (0-5), medium (6-7) and high (8) adherence. Treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4, which included questions about ADEs. Data were analysed using generalized ordered logistic regression with 95% confidence intervals (CIs).
RESULTS
We included 925 out of 968 patients. Overall, 42% of patients scored low, 37% medium and 21% high adherence. Satisfaction with treatment was low, with a mean (standard deviation) TSQM score for global satisfaction of 51 (14). A total of 193 (21%) patients experienced 421 ADEs - mainly dyspeptic symptoms (12%), headache (11%) and cough (11). Experiencing more ADEs reduced the odds of being adherent [low vs. medium/high: odds ratio (OR) OR 0.77 (95% CI 0.67, 0.89), and low/medium vs. high: OR 0.55 (05% CI 0.41, 0.73)]. Being more satisfied increased the odds of being adherent [low vs. medium/high: OR 1.02 (95% CI 1.01, 1.03)]. Taking medication >1 year [OR , 0.60 (95% CI 0.43, 0.83)] and taking calcium channel blockers [OR 0.71 (95% CI 0.54, 0.92)] decreased the odds for both low vs. medium/high and low/medium vs. high adherence.
CONCLUSIONS
Only one in five patients reported perfect (high) adherence to their antihypertensive treatment regimen. Experiencing ADEs and being dissatisfied with treatment were associated with lower adherence. In addition to addressing treatment satisfaction and drug safety in first-world countries, these should also be addressed in resource-poor settings, within patient consultations, to enhance adherence.
目的
本研究旨在评估不良药物事件（ADE）和治疗满意度对降压药物依从性的影响。
方法
在埃塞俄比亚的六家公立医院进行了一项横断面研究。我们纳入了正在服用降压药物的成年门诊患者。使用八点 Morisky 药物依从性量表测量依从性，该量表将依从性分为低（0-5）、中（6-7）和高（8）。使用治疗满意度问卷药物版（TSQM）版本 1.4 测量治疗满意度，该问卷包括有关 ADE 的问题。使用具有 95%置信区间（CI）的广义有序逻辑回归分析数据。
结果
我们纳入了 968 名患者中的 925 名。总体而言，42%的患者得分较低，37%的患者得分中等，21%的患者得分较高。治疗满意度低，全球满意度的平均（标准差）TSQM 评分 51（14）。共有 193 名（21%）患者发生了 421 起 ADE，主要为消化不良症状（12%）、头痛（11%）和咳嗽（11%）。经历更多的 ADE 会降低依从的可能性[低 vs. 中/高：比值比（OR）0.77（95%CI 0.67，0.89），低/中 vs. 高：OR 0.55（05%CI 0.41，0.73）]。治疗满意度更高会增加依从的可能性[低 vs. 中/高：OR 1.02（95%CI 1.01，1.03）]。服用药物>1 年[OR，0.60（95%CI 0.43，0.83）]和服用钙通道阻滞剂[OR 0.71（95%CI 0.54，0.92）]会降低低 vs. 中/高和低/中 vs. 高依从性的可能性。
结论
只有五分之一的患者报告了完美（高）的降压治疗方案依从性。经历 ADE 和对治疗不满意与较低的依从性相关。除了在第一世界国家解决治疗满意度和药物安全性问题外，在资源匮乏的环境中，也应该在患者咨询中解决这些问题，以提高依从性。
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