慢性乙型肝炎口服抗病毒治疗的依从性及感知到的障碍
Adherence and perceived barriers to oral antiviral therapy for chronic hepatitis B.
作者信息
Xu Kerui, Liu Li-Ming, Farazi Paraskevi A, Wang Hongmei, Rochling Fedja A, Watanabe-Galloway Shinobu, Zhang Jian-Jun
机构信息
a Department of Epidemiology, College of Public Health , University of Nebraska Medical Center , Omaha , NE , USA.
b Department of Hepatology , Hubei Third People's Hospital , Wuhan , Hubei , China.
出版信息
Glob Health Action. 2018;11(1):1433987. doi: 10.1080/16549716.2018.1433987.
BACKGROUND
Globally, of the 248 million people chronically infected with the hepatitis B virus (HBV), 74 million reside in China. Five oral nucleot(s)ide analogs (NUCs) have been approved for the treatment of chronic hepatitis B (CHB) in China.
OBJECTIVES
The aims of this study were to determine rates of adherence to NUC therapy in patients with CHB, to identify the self-perceived barriers to adherence, and to examine the factors associated with adherence.
METHODS
Questionnaire-based interviews were administered among Chinese patients with CHB at hepatology clinics of a tertiary hospital in the city of Wuhan, China. Adults aged 18 years or older prescribed with NUCs were recruited and interviewed to complete a 27-item questionnaire in a private setting, and adherence was measured using the Morisky Medication Adherence Scale (MMAS-8).
RESULTS
Among 369 participants, only 16.5% had high adherence (score of 8), 32.2% had medium adherence (score of 6 to <8), and 51.2% were measured with low adherence (score of <6). A logistic regression model was used to determine the factors associated with medication adherence. Significant predictors of high adherence consisted of urban residency, non-cirrhotic status, not using prescribed pills other than HBV medications, and reminders from family members. The five most common reasons for skipping NUCs were that medication(s) are expensive (48.7%), forgetfulness (45.1%), have experienced or worry about potential side effects (19.8%), do not want others to know about my medication(s) usage (18.5%), and ran out of pills and do not have time to refill (15.9%).
CONCLUSIONS
This study revealed that adherence rates to oral antiviral therapy were far from optimal. This finding should generate public attention, and it would be beneficial for interventional programs to target Chinese patients from rural regions, as well as patients with low socioeconomic status, cirrhosis, and taking multiple medications.
背景
在全球范围内，2.48亿慢性感染乙肝病毒（HBV）的人群中，有7400万人居住在中国。在中国，有五种口服核苷类似物（NUCs）已被批准用于治疗慢性乙型肝炎（CHB）。
目的
本研究旨在确定CHB患者对NUC治疗的依从率，找出自我认知的依从障碍，并检查与依从性相关的因素。
方法
在中国武汉市一家三级医院的肝病门诊，对CHB中国患者进行了基于问卷的访谈。招募了18岁及以上且正在服用NUCs的成年人，并在私密环境中进行访谈以完成一份包含27个项目的问卷，使用Morisky药物依从性量表（MMAS - 8）来衡量依从性。
结果
在369名参与者中，只有16.5%具有高依从性（得分8分），32.2%具有中等依从性（得分6至<8分），51.2%的依从性较低（得分<6分）。使用逻辑回归模型来确定与药物依从性相关的因素。高依从性的显著预测因素包括城市居住、非肝硬化状态、不服用除HBV药物以外的处方药以及家人的提醒。漏服NUCs最常见的五个原因是药物昂贵（48.7%）、忘记（45.1%）、经历过或担心潜在副作用（19.8%）、不想让别人知道自己的用药情况（18.5%）以及药物用完且没有时间再去取药（15.9%）。
结论
本研究表明口服抗病毒治疗的依从率远未达到最佳。这一发现应引起公众关注，针对农村地区的中国患者以及社会经济地位低、患有肝硬化和正在服用多种药物的患者开展干预项目将是有益的。
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