心肌梗死后依从性的决定因素及其对健康相关生活质量的影响：一项前瞻性队列研究。
Determinants of adherence and effects on health-related quality of life after myocardial infarction: a prospective cohort study.
机构信息
Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-Universität München, Ludwigstr. 28 RG, 80539, Munich, Germany.
Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
出版信息
BMC Geriatr. 2018 Jun 7;18(1):136. doi: 10.1186/s12877-018-0827-y.
BACKGROUND
Adherence to recommendations and medication is deemed to be important for effectiveness of case management interventions. Thus, reasons for non-adherence and effects on health-related quality of life (HRQoL) should be fully understood. The objective of this research was to identify determinants of non-adherence to medication and recommendations, and to test whether increased adherence improved HRQoL in patients after myocardial infarction (MI) in a case management intervention.
METHODS
Data were obtained from the intervention group of the KORINNA study, a randomized controlled trail of a nurse-led case management intervention with targeted recommendations in the elderly after MI in Germany. Reasons for non-adherence were described. Logistic mixed effects models and OLS (ordinary least squares) were used to analyze the effect of recommendations on the probability of adherence and the association between adherence and HRQoL.
RESULTS
One hundred and twenty-seven patients with 965 contacts were included. Frequent reasons for non-adherence to medication and recommendations were "forgotten" (22%; 11%), "reluctant" (18%; 18%), "side effects" (38%; 7%), "the problem disappeared" (6%; 13%), and "barriers" (0%; 13%). The probability of adherence was lowest for disease and self-management (38%) and highest for visits to the doctor (61%). Only if patients diverging from prescribed medication because of side effects were also considered as adherent, 3-year medication adherence was associated with a significant gain of 0.34 quality-adjusted life years (QALYs).
CONCLUSIONS
Most important determinants of non-adherence to medication were side effects, and to recommendations reluctance. Recommended improvements in disease and self-management were least likely adhered. Medication adherence was associated with HRQoL.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN02893746 , retrospectively registered, date assigned 27/03/2009.
背景
坚持建议和药物治疗被认为对病例管理干预的效果很重要。因此，应该充分了解不遵守医嘱的原因和对健康相关生活质量（HRQoL）的影响。本研究的目的是确定不遵守药物和建议的决定因素，并检验在心肌梗死（MI）后的病例管理干预中，增加依从性是否能改善患者的 HRQoL。
方法
数据来自德国针对老年 MI 患者的以护士为主导的病例管理干预和有针对性建议的 KORINNA 研究的干预组，这是一项随机对照试验。描述了不遵守医嘱的原因。使用逻辑混合效应模型和 OLS（普通最小二乘法）分析建议对依从性概率的影响，以及依从性与 HRQoL 之间的关联。
结果
共纳入 127 例患者，965 次就诊。不遵守药物和建议的常见原因是“忘记”（22%；11%）、“不情愿”（18%；18%）、“副作用”（38%；7%）、“问题消失”（6%；13%）和“障碍”（0%；13%）。对疾病和自我管理的依从性最低（38%），对看医生的依从性最高（61%）。只有当因副作用而偏离规定药物的患者也被视为依从者时，3 年的药物依从性与显著增加 0.34 个质量调整生命年（QALYs）相关。
结论
不遵守药物治疗的最重要决定因素是副作用和对建议的不情愿。最不可能坚持的是对疾病和自我管理的建议改进。药物依从性与 HRQoL 相关。
试验注册
当前对照试验 ISRCTN02893746，回顾性注册，日期为 2009 年 3 月 27 日。
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