血液肿瘤患者居家环境下药物不依从的流行状况及相关因素。
Prevalence and associated factors of medication non-adherence in hematological-oncological patients in their home situation.
机构信息
Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands.
Cancer Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
出版信息
BMC Cancer. 2017 Nov 9;17(1):739. doi: 10.1186/s12885-017-3735-1.
BACKGROUND
Medication non-adherence is associated with poor health outcomes and increased health care costs. Depending on definitions, reported non-adherence rates in cancer patients ranges between 16 and 100%, which illustrates a serious problem. In malignancy, non-adherence reduces chances of achievement of treatment response and may thereby lead to progression or even relapse. Except for Chronic Myeloid Leukemia (CML), the extent of non-adherence has not been investigated in hematological-oncological patients in an outpatient setting. In order to explore ways to optimize cancer treatment results, this study aimed to assess the prevalence of self-administered medication non-adherence and to identify potential associated factors in hematological-oncological patients in their home situation.
METHODS
This is an exploratory cross-sectional study, carried out at the outpatient clinic of the Department of Hematology at the VU University medical center, Amsterdam, the Netherlands between February and April 2014. Hematological-oncological outpatients were sent questionnaires retrieving information on patient characteristics, medication adherence, beliefs about medication, anxiety, depression, coping, and quality of life. We performed uni- and multivariable analysis to identify predictors for medication non-adherence.
RESULTS
In total, 472 participants were approached of which 259 (55%) completed the questionnaire and met eligibility criteria. Prevalence of adherence in this group (140 male; 54,1%; median age 60 (18-91)) was 50%. In univariate analysis, (lower) age, (higher) education level, living alone, working, perception of receiving insufficient social support, use of bisphosphonates, depression, helplessness (ICQ), global health, role function, emotional function, cognitive function, social functioning, fatigue, dyspnea, diarrhea were found to be significantly related (p = <0.20) to medication non-adherence. In multivariable analysis, younger age, (higher) education level and fatigue remained significantly related (p = <0.10) to medication non-adherence.
CONCLUSIONS
This cross-sectional study shows that 50% of the participants were non-adherent. Lower age, living alone and perception of insufficient social support were associated factors of non-adherence in hematological-oncological adult patients in their home-situation.
背景
药物依从性差与健康状况不佳和医疗保健费用增加有关。根据不同的定义，癌症患者的报告不依从率在 16%至 100%之间，这说明了一个严重的问题。在恶性肿瘤中，不依从会降低治疗反应的机会，从而导致疾病进展甚至复发。除慢性髓性白血病（CML）外，在门诊环境中尚未研究血液肿瘤患者的不依从程度。为了探索优化癌症治疗结果的方法，本研究旨在评估血液肿瘤患者在家中自我管理药物不依从的发生率，并确定潜在的相关因素。
方法
这是一项探索性横断面研究，于 2014 年 2 月至 4 月在荷兰阿姆斯特丹 VU 大学医学中心血液科门诊进行。血液肿瘤门诊患者收到了问卷，以获取患者特征、药物依从性、药物信念、焦虑、抑郁、应对和生活质量信息。我们进行了单变量和多变量分析，以确定药物不依从的预测因素。
结果
共接触了 472 名参与者，其中 259 名（55%）完成了问卷并符合入选标准。该组的依从率（140 名男性；54.1%；中位年龄 60（18-91）岁）为 50%。在单变量分析中，（较低）年龄、（较高）教育程度、独居、工作、感知到社会支持不足、使用双膦酸盐、抑郁、无助感（ICQ）、总体健康、角色功能、情绪功能、认知功能、社会功能、疲劳、呼吸困难、腹泻与药物不依从显著相关（p<0.20）。在多变量分析中，年龄较小、（较高）教育程度和疲劳仍然与药物不依从显著相关（p<0.10）。
结论
这项横断面研究表明，50%的参与者不依从。年龄较小、独居和感知到社会支持不足是血液肿瘤成年患者在家中不依从的相关因素。
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