Departments of Immunology and Dermatology, University Hospital Zurich, Zurich, Switzerland.
Faculty of Medicine, University of Zurich, Zurich, Switzerland.
J Eur Acad Dermatol Venereol. 2019 Jan;33(1):234-241. doi: 10.1111/jdv.15179. Epub 2018 Aug 22.
Non-adherence to medication is a challenging problem in daily clinical practice.
To assess reasons for non-adherence in patients with chronic immune-mediated inflammatory diseases (IMIDs) in a direct comparison including evaluation of treatment necessity and concerns.
ALIGN was a non-interventional, multicountry, multicentre, self-administered, cross-sectional, epidemiologic survey study. Here, we investigate the German, Austrian and Swiss (DACH) cohort. Six hundred thirty-one patients with different IMIDs (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, Crohn's disease and ulcerative colitis) under systemic therapies were evaluated concerning adherence, beliefs of necessity and concerns towards treatment in patients with IMIDs.
The DACH cohort had significantly different levels of adherence depending on the IMID (P < 0.05) and the type of therapy (P < 0.05). Based on the significant influence of concerns on treatment adherence (P < 0.05) and the high belief of treatment necessity, patients could be classified in four attitudinal segments, which were unequally distributed throughout various IMIDs. High concerns had a significant influence on non-adherence, whereas necessity did not. Older age, female sex, TNFi mono-, conventional combination and TNFi combination therapy are positively associated with adherence.
In the DACH region, patients are less concerned about medication and believe in the necessity of treatment. Therefore, we suggest adapting the communication in the various patient groups.
不遵医嘱是日常临床实践中的一个挑战。
在直接比较中评估慢性免疫介导的炎症性疾病（IMID）患者不遵医嘱的原因，包括评估治疗的必要性和顾虑。
ALIGN 是一项非干预性、多国家、多中心、自我管理、横断面、流行病学调查研究。在这里，我们调查了德国、奥地利和瑞士（DACH）队列。对 631 名接受系统治疗的不同 IMID（类风湿关节炎、强直性脊柱炎、银屑病关节炎、斑块状银屑病、克罗恩病和溃疡性结肠炎）患者的依从性、对 IMID 患者治疗必要性的信念和对治疗的顾虑进行评估。
DACH 队列的依从性水平因 IMID（P<0.05）和治疗类型（P<0.05）而异。基于顾虑对治疗依从性的显著影响（P<0.05）和对治疗必要性的高度信念，患者可根据态度分为四个不同的群体，这些群体在不同的 IMID 中分布不均。高度关注对不遵医嘱有显著影响，而必要性则没有。年龄较大、女性、TNFi 单药、常规联合和 TNFi 联合治疗与依从性呈正相关。
在 DACH 地区，患者对药物的顾虑较少，并且相信治疗的必要性。因此，我们建议在不同的患者群体中调整沟通方式。
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