Minami Hataka R, Zemela Mark S, Ring Adam C, Williams Michael S, Smeds Matthew R
Division of Vascular Surgery, Department of Surgery, SSM Health 7547St. Louis University Hospital, St. Louis University School of Medicine, MO, USA.
Vasc Endovascular Surg. 2020 Oct;54(7):625-632. doi: 10.1177/1538574420941300. Epub 2020 Jul 15.
Patients with vascular disease have higher mortality rates than age-matched peers and medical management of coexisting diseases may alter these outcomes. We sought to understand factors associated with medication nonadherence in vascular surgery patients at a single University vascular surgery clinic over a 3-month period.
Consecutive vascular surgery patients were surveyed from June to August 2019. The survey included demographic questions, the validated Morisky Medication Adherence Scale, the 4-item Patient Health Questionnaire for Anxiety and Depression scales, and other medication-related questions. Medical and surgical histories were retrospectively collected from charts. Univariate and multivariate analyses were used to compare among high, intermediate, and low adherence.
A total of 128 (74%) of 174 patients met study inclusion criteria. On univariate analysis, lower medication adherence was associated with younger age ( = .004), anxiety and depression ( = .001), higher daily pain ( < .001), and patients who believed their medications were less important for treating their vascular disease ( < .001). Adherence was not associated with symptomatic vascular disease, gender, education level, marital status, employment, insurance, or the use of medication usage reminders. Multivariate analysis significantly predicted high adherence relative to low adherence with 5-year increase in age (odds ratio [OR] = 1.252, = .021) and low adherence relative to high adherence with greater perceived pain (OR = 0.839, = .016).
Younger age and high level of pain were associated with lower medication adherence. Informing patients of the importance of prescribed medication and addressing anxiety or depression symptoms may improve adherence.
血管疾病患者的死亡率高于年龄匹配的同龄人，并存疾病的药物治疗可能会改变这些结果。我们试图了解在一所大学血管外科诊所，3个月期间血管外科患者药物治疗不依从的相关因素。
对2019年6月至8月期间连续就诊的血管外科患者进行调查。调查内容包括人口统计学问题、经过验证的莫斯基药物依从性量表、用于焦虑和抑郁量表的4项患者健康问卷，以及其他与药物相关的问题。从病历中回顾性收集医疗和手术史。采用单因素和多因素分析比较高依从性、中等依从性和低依从性患者。
174例患者中有128例（74%）符合研究纳入标准。单因素分析显示，较低的药物依从性与较年轻的年龄（P = 0.004）、焦虑和抑郁（P = 0.001）、较高的每日疼痛程度（P < 0.001）以及认为药物对治疗血管疾病不太重要的患者（P < 0.001）相关。依从性与有症状的血管疾病、性别、教育水平、婚姻状况、就业、保险或使用药物使用提醒无关。多因素分析显示，相对于低依从性，年龄每增加5岁显著预测高依从性（优势比[OR] = 1.252，P = 0.021），相对于高依从性，疼痛感知程度较高显著预测低依从性（OR = 0.839，P = 0.016）。
较年轻的年龄和较高的疼痛程度与较低的药物依从性相关。告知患者处方药的重要性并处理焦虑或抑郁症状可能会提高依从性。
