心脏移植后与费用相关的免疫抑制药物用药不依从的流行率及其相关因素：国际多中心横断面 Bright 研究。
Prevalence and Correlates of Cost-Related Medication Nonadherence to Immunosuppressive Drugs After Heart Transplantation: The International Multicenter Cross-sectional Bright Study.
机构信息
Sandra Schönfeld, MSN Clinical Nurses Specialist, Institute of Nursing Science, Department Public Health, University of Basel; and University Hospital Basel, Switzerland. Kris Denhaerynck, PhD, RN Postdoctoral Fellow, Institute of Nursing Science, Department Public Health, University of Basel, Switzerland. Lut Berben, PhD, RN Clinical Nurse Specialist, University Hospital Basel, Switzerland. Fabienne Dobbels, PhD, MSc Associate Professor, Academic Center for Nursing and Midwifery, Department Primary Care and Public Health, Faculty of Medicine, KU Leuven, Belgium. Cynthia L. Russell, PhD, RN Professor, School of Nursing, University of Missouri-Kansas City, Missouri. Marisa G. Crespo-Leiro, MD Head Heart Transplant Program, Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, INIBIC, Universidade da Coruña (UDC), La Coruña, Spain. Sabina De Geest, PhD, RN, FAAN, FRCN Professor of Nursing, Director of the Institute of Nursing Science and Chair Department of Public Health, University of Basel, Switzerland.
出版信息
J Cardiovasc Nurs. 2020 Nov/Dec;35(6):519-529. doi: 10.1097/JCN.0000000000000683.
BACKGROUND
Cost-related medication nonadherence (CRMNA) refers to not taking medications as prescribed because of difficulties paying for them.
OBJECTIVES
The aims of this study were (1) to assess the prevalence of CRMNA to immunosuppressants in heart transplant recipients internationally and (2) to determine multilevel correlates (patient, center, and healthcare system levels) of CRMNA.
METHODS
Using data from the cross-sectional international BRIGHT study, applying multistaged sampling, CRMNA was assessed via 3 self-report items in 1365 patients from 36 heart transplant centers in 11 countries. Cost-related medication nonadherence was defined as any positive answer on any of the 3 items. Healthcare system-level (ie, insurance coverage, out-of-pocket expenditures) and patient-level (ie, intention, perceived financial burden, cost as a barrier, a health belief regarding medication benefits, cost-related self-efficacy, and demographic factors) CRMNA correlates were assessed. Correlates were examined using mixed logistic regression analysis.
RESULTS
Across all study countries, CRMNA had an average prevalence of 2.6% (range, 0% [Switzerland/Brazil] to 9.8% [Australia]) and was positively related to being single (odds ratio, 2.29; 95% confidence interval, 1.17-4.47), perceived financial burden (odds ratio, 2.15; 95% confidence interval, 1.55-2.99), and cost as a barrier (odds ratio, 2.60; 95% confidence interval, 1.66-4.07). Four protective factors were identified: white ethnicity (odds ratio, 0.37; 95% confidence interval, 0.19-0.74), intention to adhere (odds ratio, 0.44; 95% confidence interval, 0.31-0.63), self-efficacy (odds ratio, 0.54; 95% confidence interval, 0.43-0.67), and belief about medication benefit (odds ratio, 0.70; 95% confidence interval, 0.57-0.87). Regarding variability, 81.3% was explained at the patient level; 13.8%, at the center level; and 4.8%, at the country level.
CONCLUSION
In heart transplant recipients, the CRMNA prevalence varies across countries but is lower than in other chronically ill populations. Identified patient-level correlates are novel (ie, intention to adhere, cost-related barriers, and cost-related self-efficacy) and indicate patient-perceived medication cost burden.
背景
与费用相关的药物不依从性（CRMNA）是指由于支付药物费用困难而未按规定服用药物。
目的
本研究的目的是（1）评估国际心脏移植受者中与免疫抑制剂相关的 CRMNA 的流行率，以及（2）确定 CRMNA 的多水平相关性（患者、中心和医疗保健系统水平）。
方法
使用来自国际 BRIGHT 研究的横断面数据，通过 36 个国家的 36 个心脏移植中心的 1365 名患者进行多阶段抽样，通过 3 项自我报告项目评估 CRMNA。CRMNA 定义为任何 3 项中的任何一个项目的阳性回答。评估了医疗保健系统水平（即保险覆盖范围、自付支出）和患者水平（即意图、感知财务负担、费用作为障碍、对药物益处的健康信念、与费用相关的自我效能感以及人口统计学因素）的 CRMNA 相关性。使用混合逻辑回归分析检查相关性。
结果
在所有研究国家中，CRMNA 的平均流行率为 2.6%（范围为 0%[瑞士/巴西]至 9.8%[澳大利亚]），与单身（优势比，2.29；95%置信区间，1.17-4.47）、感知财务负担（优势比，2.15；95%置信区间，1.55-2.99）和费用作为障碍（优势比，2.60；95%置信区间，1.66-4.07）呈正相关。确定了四个保护因素：白种人（优势比，0.37；95%置信区间，0.19-0.74）、用药意愿（优势比，0.44；95%置信区间，0.31-0.63）、自我效能感（优势比，0.54；95%置信区间，0.43-0.67）和对药物益处的信念（优势比，0.70；95%置信区间，0.57-0.87）。关于变异性，81.3%在患者水平上得到解释；13.8%在中心水平上得到解释；4.8%在国家水平上得到解释。
结论
在心脏移植受者中，CRMNA 的流行率因国家而异，但低于其他慢性病患者。确定的患者水平相关性是新颖的（即用药意愿、与费用相关的障碍和与费用相关的自我效能感），并表明患者感知的药物费用负担。
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