Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
University of Maryland School of Medicine, Baltimore MD - 655 W Baltimore St S, Baltimore, MD, 21201, USA.
Patient Educ Couns. 2021 Mar;104(3):578-584. doi: 10.1016/j.pec.2020.08.039. Epub 2020 Sep 5.
To evaluate whether engagement and affective communication among adolescents and young adults (AYAs) with chronic kidney disease (CKD), caregivers, and pediatric nephrology providers during outpatient clinic visits predicts antihypertensive medication adherence.
AYAs (n = 60, M age = 15.4 years, SD = 2.7, 40% female, 43% African American/Black) and caregivers (n = 60, 73% female) attended audio-recorded clinic visits with pediatric nephrologists (n = 12, 75% female). Recordings were analyzed using global affect ratings of the Roter Interactional Analysis System. Antihypertensive medication adherence was monitored electronically before and after clinic visits. A linear regression model evaluated associations between affect ratings and post-visit adherence.
AYAs took 84% of doses (SD = 20%) pre-visit and 82% of doses (SD = 24%) post-visit. Higher AYA engagement (β = 0.03, p = .01) and the absence of provider negative affect (β=-0.15, p = .04) were associated with higher post-visit adherence, controlling for pre-visit adherence, AYA sex, age, and race, and clustered by provider.
Post-visit adherence was higher when AYAs were rated as more engaged and providers as less negative.
AYAs with lower engagement may benefit from further adherence assessment. Communication strategies designed to more actively engage AYAs in their care and diminish provider conveyance of negative affect during clinic visits may positively influence adherence among AYAs with CKD.
评估青少年和年轻成人（AYAs）与慢性肾脏病（CKD）、照顾者和儿科肾病医生在门诊就诊期间的互动和情感沟通是否能预测降压药物的依从性。
AYAs（n=60，M 年龄=15.4 岁，SD=2.7，40%为女性，43%为非裔/黑人）和照顾者（n=60，73%为女性）与儿科肾病医生（n=12，75%为女性）一起参加了录音门诊就诊。使用 Roter 互动分析系统的整体情感评分对录音进行了分析。在就诊前后通过电子方式监测降压药物的依从性。线性回归模型评估了情感评分与就诊后依从性之间的关联。
AYAs 在就诊前服用了 84%的剂量（SD=20%），在就诊后服用了 82%的剂量（SD=24%）。AYA 的参与度较高（β=0.03，p=.01）和提供者没有负面情绪（β=-0.15，p=.04）与就诊后更高的依从性相关，控制了就诊前的依从性、AYA 的性别、年龄和种族，并按提供者进行了聚类。
当 AYA 被评为更投入，而提供者的负面情绪较少时，就诊后的依从性更高。
参与度较低的 AYA 可能受益于进一步的依从性评估。旨在更积极地让 AYA 参与他们的护理，并减少提供者在就诊期间传达负面情绪的沟通策略，可能会对 CKD 青少年和年轻成人的依从性产生积极影响。
