Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain.
IBD Unit, Gastroenterology Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón University Hospital, Madrid, Spain.
Curr Med Res Opin. 2020 Feb;36(2):293-300. doi: 10.1080/03007995.2019.1676539. Epub 2019 Oct 15.
The objective of the current work was to assess the frequency of non-adherence behaviors and potential association with patients' experience with healthcare and beliefs in medicines self-reported by patients with four different chronic conditions. Patients responded anonymously to a survey comprising five non-adherence behaviors (based on physician and patient input), an assessment of patients' experience with healthcare using the validated Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC), and a validated Spanish version of the Beliefs about Medicines Questionnaire (BMQ). Associations of non-adherence behavior were analyzed using logistic regression models. Of 1530 respondents, 53.1% reported ≥1 non-adherence behavior. Non-adherence rates were 59.8% in diabetes mellitus (DM), 56.0% in rheumatic disease, 55.6% in inflammatory bowel disease, and 42.8% in human immunodeficiency virus (HIV) infection patients ( < .001). IEXPAC and BMQ scores were higher in adherent vs. non-adherent patients. In multivariate analysis, non-adherence behavior was strongly associated with lower overall BMQ, lower BMQ Necessity scores and higher BMQ Concerns scores ( < .001 for all), and with a lower IEXPAC self-management score ( = .007), but not with the overall IEXPAC score. Non-adherence was more frequent in DM patients compared with HIV infection patients ( < .001). Patients' beliefs in medicines-a lower perception for the necessity of medication, and higher concerns in taking medication-and low patient self-management experience score were associated with non-adherence behavior. These are modifiable aspects that need to be addressed to increase medication adherence in chronic disease.
本研究旨在评估四种不同慢性疾病患者的不依从行为的频率及其与患者对医疗保健体验和对药物的信念之间的潜在关联。患者匿名回答了一份包含五种不依从行为（基于医生和患者的意见）的调查问卷，该问卷使用经过验证的慢性疾病患者体验评估工具（IEXPAC）评估了患者对医疗保健的体验，以及经过验证的西班牙语版药物信念问卷（BMQ）。使用逻辑回归模型分析不依从行为的关联。在 1530 名受访者中，53.1%报告了≥1 种不依从行为。糖尿病（DM）患者的不依从率为 59.8%，风湿性疾病患者为 56.0%，炎症性肠病患者为 55.6%，人类免疫缺陷病毒（HIV）感染患者为 42.8%（<0.001）。依从性患者的 IEXPAC 和 BMQ 评分均高于不依从性患者。多变量分析显示，不依从行为与总体 BMQ 较低、BMQ 必要性评分较低、BMQ 顾虑评分较高（均<0.001）以及 IEXPAC 自我管理评分较低（=0.007）显著相关，但与总体 IEXPAC 评分无关。与 HIV 感染患者相比，DM 患者的不依从行为更为频繁（<0.001）。患者对药物的信念（对药物必要性的认知较低，对药物的顾虑较高）和低患者自我管理体验评分与不依从行为相关。这些是需要解决的可改变方面，以提高慢性疾病患者的药物依从性。
