Hamad Yasir, Dodda Sai, Frank Allison, Beggs Joe, Sleckman Christopher, Kleinschmidt Glen, Lane Michael A, Burnett Yvonne
Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
St. Louis College of Pharmacy, St. Louis, Missouri, USA.
Open Forum Infect Dis. 2020 Jun 2;7(6):ofaa205. doi: 10.1093/ofid/ofaa205. eCollection 2020 Jun.
Nonadherence to medication is a burden to the US health care system and is associated with poor clinical outcomes. Data on outpatient parenteral antimicrobial therapy (OPAT) treatment plan adherence are lacking. The purpose of this study is to determine the rate of nonadherence and factors associated with it.
We surveyed patients discharged from a tertiary hospital on OPAT between February and August 2019 about their baseline characteristics, OPAT regimen, adherence, and experience with OPAT.
Sixty-five patients responded to the survey. The median age was 62 years, and 56% were male. The rate of reported nonadherence to intravenous (IV) antibiotics was 10%. Factors associated with nonadherence to IV antibiotics included younger age, household income of <$20000, and lack of time for administering IV antibiotics (30 vs 64 years, < .01; 83% vs 20%, < .01, and 33% vs 4%, = .04, in the nonadherent vs adherent groups, respectively), while less frequent administration (once or twice daily) and having friend or family support during IV antibiotic administration were associated with better adherence (17% vs 76%, < .01, and 17% vs 66%, = .03, in the nonadherent vs adherent groups, respectively). Most patients attended their infectious diseases clinic visits (n = 44, 71%), and the most commonly cited reasons for missing an appointment were lacking transportation (n = 12, 60%), not feeling well (n = 8, 40%), and being unaware of the appointment (n = 6, 30%).
Less frequent antibiotic dosing and better social support were associated with improved adherence to OPAT. In contrast, younger age, lower income, and lack of time were associated with nonadherence.
不坚持服药给美国医疗保健系统带来负担，并与不良临床结局相关。目前缺乏关于门诊胃肠外抗菌治疗（OPAT）治疗计划依从性的数据。本研究的目的是确定不依从率及其相关因素。
我们对2019年2月至8月间从一家三级医院出院接受OPAT治疗的患者进行了调查，了解他们的基线特征、OPAT治疗方案、依从性以及OPAT治疗经历。
65名患者回复了调查。中位年龄为62岁，56%为男性。报告的静脉注射（IV）抗生素不依从率为10%。与IV抗生素不依从相关的因素包括年龄较小、家庭收入低于20000美元以及缺乏静脉注射抗生素的时间（不依从组与依从组分别为30岁对64岁，<0.01；83%对20%，<0.01，以及33%对4%，=0.04），而给药频率较低（每日一次或两次）以及在静脉注射抗生素时有朋友或家人支持与更好的依从性相关（不依从组与依从组分别为17%对76%，<0.01，以及17%对66%，=0.03）。大多数患者参加了他们的传染病门诊就诊（n = 44，71%），错过预约最常见的原因是缺乏交通工具（n = 12，60%）、感觉不适（n = 8，40%）以及不知道预约（n = 6，30%）。
抗生素给药频率较低和更好的社会支持与OPAT依从性提高相关。相比之下，年龄较小、收入较低和缺乏时间与不依从相关。
