患者对连续护理的感知与口服抗癌治疗的依从性：一项前瞻性队列中介研究。

Patients' Perceived Continuity of Care and Adherence to Oral Anticancer Therapy: a Prospective Cohort Mediation Study.

机构信息

The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel.

School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.

出版信息

J Gen Intern Med. 2021 Jun;36(6):1525-1532. doi: 10.1007/s11606-021-06704-w. Epub 2021 Mar 25.

DOI:10.1007/s11606-021-06704-w

PMID:33768501

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8175494/

Abstract

BACKGROUND

Oral anticancer therapy (OACT) poses adherence-related challenges to patients while generating a setting in which both primary care physicians (PCPs) and oncologists are involved in the active treatment of cancer. Continuity of care (COC) was shown to be associated with medication adherence. While maintaining COC is a central role of the PCP, how this affects continuity with oncologists, and jointly affects OACT adherence, is yet unknown.

OBJECTIVES

To explore how aspects of COC act together to promote OACT adherence. Specifically, to examine whether better personal continuity with the PCP leads to better personal continuity with the oncologist, which together lead to better cross-boundary continuity between the oncologist and the PCP, jointly leading to good adherence to OACT.

DESIGN AND SETTING

A prospective cohort study conducted in five oncology centers in Israel. A bootstrapping method was used to test the serial mediation model.

PARTICIPANTS

Adult patients (age > 18 years) receiving a first OACT prescription (n = 119) were followed for 120 days.

MAIN MEASURES

The Nijmegen Continuity Questionnaire was used to assess patients' perceived personal and cross-boundary continuity. The medication possession ratio was used to measure adherence.

KEY RESULTS

Better personal continuity with the PCP was associated with better personal continuity with the oncologist (B = 0.35, p < 0.001), which was associated with better cross-boundary continuity (B = 0.33, p < 0.001), which, in turn, was associated with good adherence to OACT (B = 0.46, p = 0.03). Additionally, the indirect effect of personal continuity with the PCP on adherence to OACT through the mediation of personal continuity with the oncologist and cross-boundary continuity was found to be statistically significant (B = 0.053, 95% CI 0.0006-0.17).

CONCLUSIONS

In a system where the PCP is the case manager, cancer patients' perceived personal continuity with the PCP has an essential role for initiating a sequence of care delivery events that positively affect OACT adherence.

摘要

背景

口服抗癌治疗（OACT）给患者带来了与药物依从性相关的挑战，同时也为初级保健医生（PCP）和肿瘤医生积极参与癌症治疗创造了条件。连续性护理（COC）与药物依从性相关。虽然保持 COC 是 PCP 的核心角色，但它如何影响与肿瘤医生的连续性，以及共同影响 OACT 的依从性，目前尚不清楚。

目的

探索 COC 的各个方面如何共同促进 OACT 的依从性。具体来说，研究更好的个人与 PCP 的连续性是否会导致更好的个人与肿瘤医生的连续性，这两者共同导致肿瘤医生和 PCP 之间更好的跨边界连续性，从而共同促进 OACT 的良好依从性。

设计和设置

在以色列的五个肿瘤中心进行的前瞻性队列研究。使用自举法检验串联中介模型。

参与者

接受首次 OACT 处方的成年患者（年龄>18 岁）（n=119）随访 120 天。

主要测量指标

使用奈梅亨连续性问卷评估患者对个人和跨边界连续性的感知。药物持有率用于衡量药物的依从性。

主要结果

与 PCP 更好的个人连续性与与肿瘤医生更好的个人连续性相关（B=0.35，p<0.001），这与更好的跨边界连续性相关（B=0.33，p<0.001），而这又与 OACT 的良好依从性相关（B=0.46，p=0.03）。此外，通过肿瘤医生和跨边界连续性的中介作用，发现 PCP 对 OACT 依从性的个人连续性的间接影响具有统计学意义（B=0.053，95%CI 0.0006-0.17）。