神经科患者药物治疗不依从的聚类现象。

Clusters of non-adherence to medication in neurological patients.

机构信息

Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Aging, Jena University Hospital, Jena, Germany.

出版信息

Res Social Adm Pharm. 2019 Dec;15(12):1419-1424. doi: 10.1016/j.sapharm.2019.01.001. Epub 2019 Feb 11.

DOI:10.1016/j.sapharm.2019.01.001

PMID:30772239

Abstract

BACKGROUND

Non-adherence to medication is a common and serious problem in health care. To develop more effective interventions to improve adherence, there is a need for a better understanding of the individual types of non-adherence.

OBJECTIVE

To determine clusters of non-adherence in neurological patients using a complex adherence questionnaire.

METHODS

In this observational, monocentric study 500 neurological patients (consecutive sampling) were recruited in the Department of Neurology at the Jena University Hospital, Germany (outpatient clinic, wards) over a period of 5 months. Patients with severe dementia or delirium who were unable to complete the questionnaire were excluded. Due to missing adherence data, in total, 429 patients with common neurological disorders were analyzed. Different types and clusters of non-adherence using the German Stendal Adherence to Medication Score (SAMS) were determined.

RESULTS

For the 429 patients, the mean age was 63 years (SD = 16), 189 were female. According to the SAMS total score 74 (17.2%) were fully adherent, 252 (58.7%) showed moderate non-adherence and 103 (24%) showed clinically significant non-adherence. Principal component analysis with Varimax rotation revealed three independent factors explaining 60.5% of the SAMS variance. The bulk of non-adherence was attributed to modifications of medication (41.7%) and forgetting to take the medication (33.2%) followed by lack of knowledge 25.1% about reasons, dosages and time of administration for the medication.

CONCLUSIONS

Intentional non-adherence was the primary self-reported behavior identified among non-adherent neurological participants. Many patients modified their prescribed medication due to various reasons, such as side effects or lacking effect. Different clusters require different interventions. While for the cluster ´forgetfulness' the reduction of poly-medication and a behavioral approach with reminders seems reasonable, patients in cluster ´missing knowledge' and cluster ´modifications' may need an educational approach.

摘要

背景

不遵医嘱是医疗保健中一个常见且严重的问题。为了开发更有效的干预措施来提高患者的服药依从性，我们需要更好地了解导致不遵医嘱的各种因素。

目的

使用复杂的依从性问卷确定神经科患者的不依从类型。

方法

在这项观察性、单中心研究中，德国耶拿大学医院神经内科在 5 个月的时间内（门诊、病房）连续招募了 500 名神经科患者（连续抽样）。由于无法完成问卷而被排除的患者包括患有严重痴呆或意识混乱的患者。由于存在缺失的依从性数据，因此共分析了 429 名患有常见神经疾病的患者。使用德国斯腾达尔药物依从性评分（SAMS）确定了不同类型和不依从类型的聚类。

结果

对于这 429 名患者，平均年龄为 63 岁（标准差=16），其中 189 名为女性。根据 SAMS 总分，74 名患者（17.2%）完全依从，252 名患者（58.7%）中度不依从，103 名患者（24%）表现出明显的不依从。使用方差最大旋转的主成分分析显示，三个独立因素解释了 SAMS 方差的 60.5%。大部分不依从行为归因于药物的修改（41.7%）和忘记服药（33.2%），其次是缺乏对药物的使用原因、剂量和时间的了解（25.1%）。