Whitley Heather P, Fermo Joli D, Ragucci Kelly, Chumney Elinor C
Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy and Department of Community and Rural Medicine, University of Alabama School of Medicine, Tuscaloosa, Alabama (USA).
Department of Pharmacy and Clinical Sciences, South Carolina College of Pharmacy. South Carolina (USA).
Pharm Pract (Granada). 2006 Oct-Dec;4(4):183. doi: 10.4321/s1885-642x2006000400006. Epub 2006 Dec 12.
Medication adherence is an integral aspect of disease state management for patients with chronic illnesses, including diabetes mellitus. It has been hypothesized that patients with diabetes who have poor medication adherence may have less knowledge of overall therapeutic goals and may be less likely to attain these goals.
The purpose of this study was to assess self-reported medication adherence, knowledge of therapeutic goals (hemoglobin A1C [A1C], low density lipoprotein cholesterol [LDL-C] and blood pressure [BP]), and goal attainment in adult patients with diabetes.
A survey was created to assess medication adherence, knowledge of therapeutic goals, and goal attainment for adult patients with diabetes followed at an internal medicine or a family medicine clinic. Surveys were self-administered prior to office visits. Additional data were collected from the electronic medical record. Statistical analysis was performed.
A total of 149 patients were enrolled. Knowledge of therapeutic goals was reported by 14%, 34%, and 18% of survived patients for LDL-C, BP, and A1C, respectively. Forty-six percent, 37%, and 40% of patients achieved LDL-C, BP, and A1C goals, respectively. Low prescribing of cholesterol-lowering medications was an interesting secondary finding; 36% of patients not at LDL-C goal had not been prescribed a medication targeted to lower cholesterol. Forty-eight percent of patients were medication non-adherent; most frequently reported reasons for non-adherence were forgot (34%) and too expensive (14%). Patients at A1C goal were more adherent than patients not at goal (p=0.025).
The majority did not reach goals and were unknowledgeable of goals; however, most were provided prescriptions to treat these parameters. Goal parameters should be revisited often amongst multidisciplinary team members with frequent and open communications. Additionally, it is imperative that practitioners discuss the importance of medication adherence with every patient at every visit.
药物依从性是慢性病患者（包括糖尿病患者）疾病状态管理的一个重要方面。据推测，药物依从性差的糖尿病患者可能对总体治疗目标了解较少，实现这些目标的可能性也较小。
本研究旨在评估成年糖尿病患者自我报告的药物依从性、治疗目标（糖化血红蛋白[A1C]、低密度脂蛋白胆固醇[LDL-C]和血压[BP]）知识以及目标达成情况。
创建了一项调查，以评估在内科或家庭医学诊所就诊的成年糖尿病患者的药物依从性、治疗目标知识和目标达成情况。调查在门诊就诊前自行填写。从电子病历中收集了其他数据，并进行了统计分析。
共纳入149例患者。存活患者中分别有14%、34%和18%报告了解LDL-C、BP和A1C的治疗目标。分别有46%、37%和40%的患者实现了LDL-C、BP和A1C目标。降胆固醇药物处方量低是一个有趣的次要发现；36%未达到LDL-C目标的患者未被开具降低胆固醇的药物。48%的患者存在药物不依从情况；最常报告的不依从原因是忘记（34%）和费用太高（14%）。达到A1C目标的患者比未达到目标的患者依从性更高（p = 0.025）。
大多数患者未达到目标且对目标不了解；然而，大多数患者都得到了针对这些指标的处方。多学科团队成员应经常重新审视目标参数，并保持频繁且开放的沟通。此外，从业者每次就诊时都必须与每位患者讨论药物依从性的重要性。
