低收入、无保险的多重慢性病患者的药物依从性和障碍。
Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions.
机构信息
Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain; Department of Health Sciences, Armstrong State University, 11935 Abercorn St, Savannah, GA, 31419, USA.
Department of General Studies, Point University-Savannah Campus, 55 Al Henderson Blvd, Savannah, GA, 31419, USA.
出版信息
Res Social Adm Pharm. 2019 Jun;15(6):744-753. doi: 10.1016/j.sapharm.2018.09.006. Epub 2018 Sep 15.
BACKGROUND
Poor adherence to long-term therapies is a public health concern that affects all populations. Little is known about the context of adherence in chronic diseases for the uninsured population in the United States.
OBJECTIVE
To evaluate medication adherence and barriers among low-income, uninsured adults recently initiating new therapy for a chronic disease.
METHODS
A cross-sectional study in two Community Health Centers located in Chatham County, Georgia, was performed between September and December 2015. Patients, randomly selected for inclusion in the study, were eligible if they had been prescribed medication for 2 or more chronic conditions and had recently started a new medication regimen. The Morisky-Green-Levine questionnaire was used to assess adherence. Potential barriers were analyzed using the Multidimensional Model proposed by the World Health Organization-social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Multivariate logistic regression models were used to analyze factors associated with non-adherence.
RESULTS
A total of 150 participants were interviewed at 6 months after treatment initiation. Non-adherence was reported by 52% of the participants. Higher adjusted odds of non-adherence were observed in participants who did not receive information about their medications (adjusted odds ratio [AOR] = 2.40, 95% confidence interval [CI] = 1.01-5.74), did not regularly visit a primary health-care provider (AOR = 2.74, 95% CI = 1.09-6.88), and had changes in their treatment (AOR = 3.75, 95% CI = 1.62-8.70). Alternatively, adjusted odds of non-adherence were lower for patients who reported using pillboxes (AOR = 0.31, 95% CI = 0.10-0.95), having help from a caregiver (AOR = 0.15, 95% CI = 0.04-0.60), and integrating medication dosing into daily routines (AOR = 0.18, 95% CI = 0.06-0.59).
CONCLUSIONS
Medication non-adherence was common among low-income, uninsured patients initiating therapy for chronic conditions. Several modifiable barriers highlight opportunities to address medication non-adherence through multidisciplinary interventions.
背景
长期治疗依从性差是一个公共卫生问题，影响所有人群。在美国，对于没有保险的人群，关于慢性病治疗依从性的情况了解甚少。
目的
评估低收入、无保险的成年人在开始新的慢性疾病治疗方案时的药物依从性和障碍。
方法
这是 2015 年 9 月至 12 月在佐治亚州查塔姆县的两家社区卫生中心进行的一项横断面研究。随机选择符合条件的患者入组研究，他们的条件必须为正在服用 2 种或更多种治疗慢性疾病的药物，且最近开始新的药物治疗方案。采用 Morisky-Green-Levine 问卷评估依从性。使用世界卫生组织提出的多维模型分析潜在障碍，包括社会经济、医疗保健团队和系统相关、疾病相关、治疗相关和患者相关因素。采用多变量逻辑回归模型分析与不依从相关的因素。
结果
共有 150 名参与者在治疗开始后 6 个月接受了访谈。52%的参与者报告存在不依从情况。在未接受药物信息（调整后的优势比[OR] = 2.40，95%置信区间[CI] = 1.01-5.74）、未定期就诊于初级保健提供者（OR = 2.74，95% CI = 1.09-6.88）以及治疗方案发生改变的患者中，不依从的调整后比值比更高（OR = 3.75，95% CI = 1.62-8.70）。相反，报告使用药盒（OR = 0.31，95% CI = 0.10-0.95）、得到照护者帮助（OR = 0.15，95% CI = 0.04-0.60）和将药物剂量融入日常常规（OR = 0.18，95% CI = 0.06-0.59）的患者，不依从的调整后比值比更低。
结论
在开始治疗慢性疾病的低收入、无保险患者中，药物不依从现象很常见。有多种可改变的障碍，提示可以通过多学科干预来解决药物不依从问题。
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