Cea-Calvo Luis, Marín-Jiménez Ignacio, de Toro Javier, Fuster-RuizdeApodaca María J, Fernández Gonzalo, Sánchez-Vega Nuria, Orozco-Beltrán Domingo
Medical Affairs Department, MSD Spain, Madrid, Spain.
IBD Unit, Gastroenterology Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón University Hospital, Madrid, Spain.
Patient Prefer Adherence. 2020 Dec 14;14:2439-2450. doi: 10.2147/PPA.S281985. eCollection 2020.
To investigate relationships between intentional and non-intentional non-adherence behaviors and patient experience with healthcare and beliefs in medications.
This is a post hoc analysis of a cross-sectional anonymous survey distributed between May and September 2017 to patients with rheumatic disease, inflammatory bowel disease, HIV infection or diabetes mellitus from outpatient and primary care clinics in Spain. Patients answered five questions about non-adherence behaviors and completed questionnaires on their experience with healthcare (IEXPAC: Instrument to Evaluate the EXperience of PAtients with Chronic diseases) and beliefs about medicines (BMQ: Beliefs About Medicines Questionnaire).
Among 1530 respondents, 53% showed ≥1 non-adherence behavior; 35% had ≥1 non-intentional non-adherence behavior, and 33% had ≥1 intentional non-adherence behavior. Patients with HIV infection had the lowest frequency of intentional non-adherence behaviors. Non-intentional non-adherence was associated with patient beliefs (inversely with BMQ overall score) and patient experiences (inversely with IEXPAC Factor 3 sub-score, self-management). Intentional non-adherence was strongly associated with beliefs scores (directly with BMQ concerns and inversely with BMQ necessity sub-score) and inversely associated with HIV infection.
The different associations of intentional and non-intentional non-adherence behaviors found in this study help to understand how patient experiences and beliefs influence medical non-adherence, and in the development of strategies for reducing non-adherence.
探讨有意和无意的不依从行为与患者医疗体验及用药信念之间的关系。
这是一项事后分析，对2017年5月至9月间分发给西班牙门诊和基层医疗诊所中患有风湿性疾病、炎症性肠病、HIV感染或糖尿病的患者的横断面匿名调查进行分析。患者回答了五个关于不依从行为的问题，并完成了关于其医疗体验（IEXPAC：慢性病患者体验评估工具）和用药信念（BMQ：用药信念问卷）的问卷。
在1530名受访者中，53%表现出≥1种不依从行为；35%有≥1种无意的不依从行为，33%有≥1种有意的不依从行为。HIV感染患者有意不依从行为的发生率最低。无意的不依从与患者信念（与BMQ总分呈负相关）和患者体验（与IEXPAC因子3子评分，自我管理呈负相关）相关。有意不依从与信念得分密切相关（与BMQ担忧呈正相关，与BMQ必要性子评分呈负相关），且与HIV感染呈负相关。
本研究中发现的有意和无意不依从行为的不同关联有助于理解患者体验和信念如何影响医疗不依从，以及有助于制定减少不依从的策略。
