运用跨理论模型的改变阶段预测初级保健环境中 2 型糖尿病患者的药物依从性。
Using the transtheoretical model's stages of change to predict medication adherence in patients with type 2 diabetes mellitus in a primary health care setting.
机构信息
Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar.
Boden Institute, University of Sydney, Sydney, NSW, Australia.
出版信息
Daru. 2019 Jun;27(1):91-99. doi: 10.1007/s40199-019-00246-7. Epub 2019 Feb 7.
BACKGROUND
Qatar is currently experiencing a worrying increase in the prevalence of diabetes mellitus (DM). One of the most common reasons for uncontrolled DM is non-adherence to medications. The socio-behavioral intervention has proven effective in some chronic illnesses.
OBJECTIVES
To assess the stages of change (SOC) and medication adherence scores of type 2 diabetes mellitus (T2DM) patients visiting primary healthcare institutions in Qatar, and to evaluate the cause and effect relationship between SOC and adherence to antidiabetic medications.
METHODS
The 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence, and a 2-item SOC questionnaire was utilized to classify the SOC. The analysis to determine if the SOC could predict medication adherence while controlling for demographic characteristics, total number of prescribed medications and disease duration was done using hierarchical multiple regression.
RESULTS
The final analysis included 387 patients. In relation to medication adherence, majority of the patients were in the maintenance stage (76.7%), followed by the preparation stage (14.7%), the action stage (3.9%), the contemplation stage (3.4%) and the precontemplation stage (1.3%). Most of the patients were in high adherence towards antidiabetic medications (50.3%) followed by low level (26.4%) and medium level (23.3%). SOC was significant and positively predicted medication adherence, which accounted for around 58 to 60% (p < 0.001) while controlling for covariates.
CONCLUSIONS
SOC was significant and positively predicted medication adherence. The study recommends that the SOC questionnaire could potentially be used to identify patients at risk for low adherence.
背景
卡塔尔目前正经历着糖尿病（DM）患病率令人担忧的上升。DM 控制不佳的最常见原因之一是不遵医嘱用药。社会行为干预已被证明在某些慢性病中有效。
目的
评估在卡塔尔初级医疗机构就诊的 2 型糖尿病（T2DM）患者的改变阶段（SOC）和药物依从性评分，并评估 SOC 与抗糖尿病药物依从性之间的因果关系。
方法
使用 8 项 Morisky 药物依从性量表（MMAS-8）评估药物依从性，并使用 2 项 SOC 问卷对 SOC 进行分类。使用分层多元回归分析来确定 SOC 是否可以在控制人口统计学特征、规定药物总数和疾病持续时间的情况下预测药物依从性。
结果
最终分析包括 387 名患者。在药物依从性方面，大多数患者处于维持阶段（76.7%），其次是准备阶段（14.7%）、行动阶段（3.9%）、考虑阶段（3.4%）和前考虑阶段（1.3%）。大多数患者对降糖药物的依从性较高（50.3%），其次是低水平（26.4%）和中水平（23.3%）。SOC 具有显著的正向预测药物依从性，占 58%至 60%左右（p<0.001），同时控制了协变量。
结论
SOC 对药物依从性具有显著的正向预测作用。该研究建议 SOC 问卷可能有助于识别低依从风险的患者。
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