Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, Calle Alfonso X el Sabio s/n, 37007, Salamanca, Spain.
Department of Preventive Medicine and Public Health, School of Medicine, IDISNA, University of Navarra, Pamplona, Spain.
BMC Fam Pract. 2019 Sep 14;20(1):132. doi: 10.1186/s12875-019-1019-3.
Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings.
A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence 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.
The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01-1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47-0.90), having received complete treatment information (3.89, 95% CI 2.09-7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23-7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18-4.02) were independent factors associated with adherence.
Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients' education and their information needs.
治疗依从性是一个公共卫生问题，在慢性病治疗中尤为重要。初级保健实践为有效治疗和管理这些疾病提供了理想的场所。本研究旨在评估初级保健环境中慢性病患者的治疗依从性及其相关因素。
这是一项在西班牙初级保健中心进行的横断面研究，共纳入 299 名患有≥1 种慢性病并接受药物治疗的成年患者。通过面对面访谈使用 Morisky-Green-Levine 问卷评估药物依从性。使用世界卫生组织提出的多维模型，通过多变量逻辑回归模型分析与依从性相关的因素，包括社会经济、医疗团队和系统相关、疾病相关、治疗相关和患者相关因素。
治疗依从的患者比例为 55.5%。年龄较大（调整后的优势比为每增加 10 岁增加 1.31，95%CI 为 1.01-1.70）、用于药物续配的药店数量较少（0.65，95%CI 为 0.47-0.90）、接受过完整的治疗信息（3.89，95%CI 为 2.09-7.21）、对药物治疗方案有足够的了解（4.17，95%CI 为 2.23-7.80）和自我感知良好的生活质量（2.17，95%CI 为 1.18-4.02）是与依从性相关的独立因素。
慢性病患者在初级保健中的治疗依从性仍然较低。通过量身定制的多方面干预措施，实现适当的依从性水平，需要关注本研究发现的多维因素，特别是与患者教育和信息需求相关的因素。
