Department of Inflammation Biology, King's College London, London, UK.
The Royal Marsden Hospital, Applied Health Research Group, London, UK.
Lupus. 2020 Sep;29(10):1168-1178. doi: 10.1177/0961203320935977. Epub 2020 Jul 5.
The quality of physician-patient interaction can have a significant impact on medication adherence. Little is known about this relationship in patients with lupus nephritis.
A cross-sectional, quantitative study. Data collected included demographics, current medication, systemic lupus erythematosus disease activity index, medication adherence, beliefs about medicines, shared decision-making, patient-doctor depth of relationship, patient-doctor quality of relationship, interpersonal trust in a physician and illness perceptions.
Ninety-eight patients with lupus nephritis completed the questionnaires. Logistic regression indicated that medication adherence was significantly predicted by (a) interpersonal trust in a physician (B = 0.85, Wald 3.94, 95% confidence interval (CI) 1.01, 5.44; = 0.05); (b) timeline cyclical (B = -0.89, Wald 4.95, 95% CI 0.19, 0.90; < 0.05) and beliefs about the necessity of medicines (B = 0.75, Wald 4.14, 95% CI 1.03, 4.38; < 0.05). Mediation analysis showed that beliefs about the necessity of medicines significantly mediated the relationship between trust and medication adherence when adjusted for age (B = 0.48, 95% CI 0.06, 1.08; < 0.01). A further mediation analysis showed that patient-doctor depth of relationship (B = 0.05, 95% CI 0.01, 0.09; < 0.001), shared decision-making (B = 0.07, 95% CI 0.01, 0.13; < 0.001) and patient-doctor quality of relationship (B = 0.08, 95% CI 0.01, 0.16; < 0.001) significantly mediated the relationship between illness coherence and interpersonal trust in a physician.
The findings highlighted two key elements: (a) the importance of trust in relation to medication adherence; and (b) a good understanding of patients' illness is linked to a better relationship with their doctor and greater participation in shared decision-making which is associated with increased trust. Tailored psycho-educational interventions could contribute to improving the patient-doctor relationship quality, trust and increased shared decision-making, which, in turn, might improve medication adherence in patients with lupus nephritis.
医患互动的质量对药物依从性有重大影响。然而，狼疮肾炎患者的这种关系鲜为人知。
本研究为一项横断面、定量研究。收集的数据包括人口统计学资料、当前用药情况、系统性红斑狼疮疾病活动指数、药物依从性、对药物的信念、共同决策、医患关系深度、医患关系质量、对医生的人际信任和疾病认知。
98 例狼疮肾炎患者完成了问卷调查。逻辑回归分析表明，药物依从性与（a）对医生的人际信任（B=0.85，Wald 3.94，95%置信区间（CI）1.01，5.44； =0.05）；（b）时间循环（B=−0.89，Wald 4.95，95%CI 0.19，0.90； <0.05）和对药物必要性的信念（B=0.75，Wald 4.14，95%CI 1.03，4.38； <0.05）显著相关。中介分析表明，在调整年龄因素后，对药物必要性的信念在信任与药物依从性之间的关系中起中介作用（B=0.48，95%CI 0.06，1.08； <0.01）。进一步的中介分析表明，医患关系深度（B=0.05，95%CI 0.01，0.09； <0.001）、共同决策（B=0.07，95%CI 0.01，0.13； <0.001）和医患关系质量（B=0.08，95%CI 0.01，0.16； <0.001）显著中介了疾病一致性与对医生的人际信任之间的关系。
研究结果强调了两个关键要素：（a）信任与药物依从性的关系至关重要；（b）对患者疾病的深入了解与与医生的良好关系以及更多地参与共同决策有关，而这与更高的信任度有关。量身定制的心理教育干预措施可能有助于改善医患关系质量、信任度和共同决策，进而提高狼疮肾炎患者的药物依从性。
