Krska Janet, Katusiime Barbra, Corlett Sarah A
Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Chatham, Kent, UK.
Health Soc Care Community. 2018 Nov;26(6):946-959. doi: 10.1111/hsc.12624. Epub 2018 Jul 30.
Many patients find using medicines burdensome. This paper reports the types of issues people experience with medicines, using a validated measure of medicines burden, and the factors associated with high burden. The cross-sectional study involved patients presenting prescriptions at pharmacies or awaiting appointments at GP practices or outpatient clinics, during October 2015 to December 2016. Adults using at least one regular medicine were asked to complete the Living with Medicines Questionnaire V3 (LMQ-3). The LMQ-3 contains 41 statements rated on a 5-point scale (strongly agree to strongly disagree), with higher scores indicating greater burden, plus a visual analogue scale for self-reporting of overall perceived burden (VAS-burden). For a subsample, access to their medication record was requested, facilitating calculation of the complexity of their medicine regimen using the Medicine Regimen Complexity Index (MRCI). Of 1,888 questionnaires distributed, 684 were returned (36.2%) and medication records obtained for 163. The median number of medicines respondents reported using was 4 (range 1 to 26). Two-thirds (418; 67.0%) used medicines more than once daily, 67 (10.1%) required assistance with medicines and 189 (28.3%) paid a prescription charge. LMQ-3 scores showed a strong positive relationship with VAS-burden scores (r = .547; p < 0.001). LMQ-3 and VAS-burden scores were lower in older age groups, but both increased with increasing number of medicines and dosing frequency. LMQ-3 score was positively related to MRCI score (n = 163; r = .217; p = 0.005), whereas VAS-burden was not. Older respondents reported lower burden in most domains. Higher numbers and frequency of medicines, paying prescription charges, needing support and deprivation increased burden across multiple domains. Factors strongly associated with high LMQ-3 scores were: needing support, high dosing frequency and unemployment. Interventions seeking to reduce medicines burden should consider targeting individuals who need support with using medicines, use at least four medicines, more than twice daily and/or pay prescription charges.
许多患者觉得用药很麻烦。本文报告了人们在用药方面遇到的问题类型，采用了一种经过验证的药物负担衡量方法，并分析了与高负担相关的因素。这项横断面研究涉及2015年10月至2016年12月期间在药店取药或在全科医生诊所或门诊等待预约的患者。使用至少一种常规药物的成年人被要求完成《药物生活问卷V3》（LMQ - 3）。LMQ - 3包含41条陈述，按5级评分（从强烈同意到强烈不同意），得分越高表明负担越重，此外还有一个用于自我报告总体感知负担的视觉模拟量表（VAS - 负担）。对于一个子样本，要求获取他们的用药记录，以便使用药物治疗方案复杂性指数（MRCI）计算其药物治疗方案的复杂性。在分发的1888份问卷中，684份被退回（36.2%），并获取了163人的用药记录。受访者报告使用的药物中位数为4种（范围为1至26种）。三分之二（418人；67.0%）的人每天用药超过一次，67人（10.1%）需要药物协助，189人（28.3%）支付了处方费用。LMQ - 3得分与VAS - 负担得分呈强正相关（r = 0.547；p < 0.001）。年龄较大的人群中LMQ - 3和VAS - 负担得分较低，但两者都随着药物数量和给药频率的增加而升高。LMQ - 3得分与MRCI得分呈正相关（n = 163；r = 0.217；p = 0.005），而VAS - 负担得分则不然。年龄较大的受访者在大多数领域报告的负担较低。药物数量和频率增加、支付处方费用、需要支持和贫困会增加多个领域的负担。与高LMQ - 3得分密切相关的因素有：需要支持、高给药频率和失业。旨在减轻药物负担的干预措施应考虑针对那些在用药方面需要支持、每天使用至少四种药物、用药次数超过两次和/或支付处方费用的个体。
