Drangsholt Sarah H, Cappelen Ulrik W, von der Lippe Nanna, Høieggen Aud, Os Ingrid, Brekke Fredrik B
Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway.
Hemodial Int. 2019 Jan;23(1):117-125. doi: 10.1111/hdi.12717. Epub 2019 Feb 4.
Patients with end-stage renal disease are burdened by a complex medication regimen, but little is known about the belief about medicine among dialysis- and renal transplant (RTX) patients. Patients' beliefs about medicines may influence drug adherence and thereby affect morbidity and mortality. The aim of the present study was to assess the beliefs about medicine in dialysis as well as after RTX.
In a prospective study, 301 dialysis patients were followed for up to 5.5 years during which time 142 had been transplanted. Out of the transplanted patients, 110 were eligible for inclusion. The Beliefs about Medicine Questionnaire (BMQ) was used to assess the beliefs in dialysis and after transplantation. BMQ in dialysis was also compared to that of the general Norwegian population (n = 426). Multiple linear regression analyses were performed with BMQ subscales as dependent variables and sociodemographic and clinical data as independent variables.
Median age in dialysis was 62 (IQR 50-73) years, 66.1% were male and 80.7% were treated with hemodialysis. When in dialysis, 98.2% strongly believed their medications were necessary, while 34.4% reported strong concerns. Furthermore, 17.3% believed their medications to be harmful and 38.6% believed that doctors overprescribed medicines. The Necessity-concern differential had a positive score in 92.6% of the patients. Follow-up time was 55 (IQR 50-59) months. After transplantation, there was an increase in the patient-reported necessity of medication (21.9 ± 2.7 vs. 23.8 ± 1.9, P < 0.001) compared to while in dialysis. Correlations were found between patient beliefs and education, age, and depression.
Although positive beliefs about medicines increase after transplantation, concerns are high in both dialysis and after RTX. Implementing the BMQ routinely in the clinical evaluation of dialysis- and RTX patients may help to identify patients with increased risk for medical nonadherence.
终末期肾病患者承受着复杂的药物治疗方案带来的负担，但对于透析患者和肾移植患者对药物的看法却知之甚少。患者对药物的看法可能会影响药物依从性，进而影响发病率和死亡率。本研究的目的是评估透析患者以及肾移植后的患者对药物的看法。
在一项前瞻性研究中，对301名透析患者进行了长达5.5年的随访，在此期间，有142人接受了移植手术。在接受移植的患者中，110人符合纳入标准。使用药物信念问卷（BMQ）评估透析期间及移植后的信念。还将透析患者的BMQ与挪威普通人群（n = 426）的进行了比较。以BMQ分量表为因变量，社会人口统计学和临床数据为自变量进行多元线性回归分析。
透析患者的中位年龄为62岁（四分位间距50 - 73岁），男性占66.1%，80.7%接受血液透析治疗。透析时，98.2%的患者坚信他们的药物是必要的，而34.4%的患者表示非常担忧。此外，17.3%的患者认为他们的药物有害，38.6%的患者认为医生开药过多。92.6%的患者的必要性 - 担忧差异得分呈阳性。随访时间为55个月（四分位间距50 - 59个月）。与透析期间相比，移植后患者报告的用药必要性有所增加（21.9 ± 2.7对23.8 ± 1.9，P < 0.001）。发现患者信念与教育程度、年龄和抑郁之间存在相关性。
尽管移植后对药物的积极信念有所增加，但透析患者和肾移植后患者的担忧程度都很高。在透析患者和肾移植患者的临床评估中常规使用BMQ可能有助于识别药物治疗依从性风险增加的患者。
