Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Center for the Promotion of Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio.
Center for Biobehavioral Health, Nationwide Children's Hospital, Cincinnati, Ohio.
Biol Blood Marrow Transplant. 2018 Feb;24(2):381-385. doi: 10.1016/j.bbmt.2017.10.033. Epub 2017 Nov 2.
We prospectively examined rates of outpatient oral medication adherence in children after hematopoietic stem cell transplant (post-HSCT). For 6 months after first discharge post-HSCT, 50 patients (aged 0 to 16 years) and their primary caregivers agreed to store 1 oral medication in an electronic pill bottle that date and time stamps each bottle opening. Demographics, disease, donor type, and prescribed post-HSCT medication regimen were collected via chart review. For each patient percent adherence was calculated by dividing the number of doses taken as indicated by the electronic pill bottle by the number of doses prescribed for the same time period. Average percent adherence ranged from 63% at 1 month after discharge to 57% at 6 months after discharge. For patients who received an allogeneic transplant, lower adherence was associated (P < .005) with higher infection rates, after controlling for age and time since transplant. No such relationship was observed for patients who received an autologous transplant. This study demonstrates that poor oral medication adherence is prevalent, persistent, and, for patients receiving an allogeneic transplant, associated with increased incidence of infections during the outpatient treatment period. This study highlights the need for further research examining factors that hinder medication adherence as well as monitoring, promoting, and intervening to maximize medication adherence throughout the HSCT course.
我们前瞻性地研究了造血干细胞移植（post-HSCT）后儿童门诊口服药物依从率。在 post-HSCT 首次出院后 6 个月内，50 名（0 至 16 岁）患者及其主要照顾者同意将 1 种口服药物储存在电子药瓶中，该电子药瓶会记录每次打开药瓶的日期和时间。通过图表审查收集了人口统计学、疾病、供者类型和 post-HSCT 规定的药物治疗方案。对于每个患者，依从率通过将电子药瓶记录的服用剂量除以同一时间段规定的剂量数来计算。出院后 1 个月的平均依从率为 63%，出院后 6 个月的平均依从率为 57%。对于接受同种异体移植的患者，在控制年龄和移植后时间的情况下，较低的依从率与更高的感染率相关（P<0.005）。对于接受自体移植的患者，则未观察到这种关系。这项研究表明，口服药物依从率普遍存在、持续存在，并且对于接受同种异体移植的患者，与门诊治疗期间感染发生率增加相关。这项研究强调了需要进一步研究阻碍药物依从性的因素，以及监测、促进和干预以最大限度地提高整个 HSCT 过程中的药物依从性。
