Müller Sabrina, Junker Sophia, Wilke Thomas, Lommatzsch Albrecht, Schuster Alexander K, Kaymak Hakan, Ehlken Christoph, Ziemssen Focke
IPAM e.v, University of Wismar, University of Applied Sciences, Alter Holzhafen 19, 23966, Wismar, Germany.
Ingress-Health HWM GmbH, Alter Holzhafen 19, 23966, Wismar, Germany.
Int J Retina Vitreous. 2021 Jun 2;7(1):43. doi: 10.1186/s40942-021-00311-x.
To develop and validate a questionnaire for the investigation of non-adherence (NA) barriers in patients receiving intravitreal injection (IVT).
Questionnaire development and cross-sectional patient survey combined with a retrospective medical chart review.
German patients with neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) receiving anti-vascular endothelial growth factor (anti-VEGF) treatment via IVT.
The previously validated (indications: atrial fibrillation, human immunodeficiency virus, chronic inflammatory lung disease) Adherence Barriers Questionnaire (ABQ) was revised according to specifications of IVT, within the framework of an expert panel. The ABQ-IVT, which initially consisted of 24 items formulated as statements (4-point-Likert-scale ranging from "strongly agree" to "strongly disagree"), was applied in a cross-sectional survey. Evaluation of the questionnaire included an assessment of internal consistency and factor analysis. The occurrence of potential barriers in the patient sample was evaluated using descriptive statistics. To identify patient subpopulations, hierarchical cluster analysis was performed using ABQ-IVT answers as predictors. Due to difficulties in capturing NA as an external criterion, the evaluation of the questionnaire was limited to its internal validity and reliability.
Patients' answers to the ABQ-IVT questionnaire and interviews.
Of 253 patients, 234 (92%) were able to complete the ABQ-IVT questionnaire. Within the reliability analysis, the ABQ-IVT was reduced to 17 items. The condensed questionnaire demonstrated good internal consistency (Cronbach's alpha = 0.78), and factor analysis showed no evidence for subscales of the questionnaire. Nearly half of the patients (49%) reported being affected by at least three different barriers. On average, a patient was affected by 3.1 barriers. The most frequently reported barriers were "Challenge due to time commitment of physician visits" (45% of the patients), "Depression" (29%) and "Travel and opportunity costs" (27%). Cluster analysis identified six patient subpopulations, each affected by different sets of barriers and differed regarding their patient characteristics.
The ABQ-IVT is a practical and reliable instrument for identifying patient-specific barriers to IVT treatment adherence. In practice, the questionnaire may be useful in assessing whether individual patients are at higher risk of NA due to specific adherence barriers. Aside from better awareness, this allows earlier interventions, though these still need to be validated. Patient subpopulations face different barriers and may, therefore, need distinct preventative care.
开发并验证一份用于调查接受玻璃体内注射（IVT）患者的不依从性（NA）障碍的问卷。
问卷开发、横断面患者调查并结合回顾性病历审查。
接受通过IVT进行抗血管内皮生长因子（抗VEGF）治疗的德国新生血管性年龄相关性黄斑变性（nAMD）或糖尿病性黄斑水肿（DME）患者。
在一个专家小组的框架内，根据IVT的规范对先前已验证（适应症：心房颤动、人类免疫缺陷病毒、慢性炎症性肺病）的依从性障碍问卷（ABQ）进行修订。最初由24项陈述组成（4点李克特量表，范围从“强烈同意”到“强烈不同意”）的ABQ-IVT被应用于一项横断面调查。问卷评估包括内部一致性评估和因子分析。使用描述性统计评估患者样本中潜在障碍的发生情况。为了识别患者亚群，使用ABQ-IVT答案作为预测指标进行分层聚类分析。由于难以将NA作为外部标准进行捕捉，问卷评估仅限于其内部有效性和可靠性。
患者对ABQ-IVT问卷的回答及访谈。
253例患者中，234例（92%）能够完成ABQ-IVT问卷。在可靠性分析中，ABQ-IVT缩减至17项。精简后的问卷显示出良好的内部一致性（Cronbach's alpha = 0.78），因子分析未发现问卷存在子量表的证据。近一半的患者（49%）报告受到至少三种不同障碍的影响。平均而言，一名患者受到3.1种障碍的影响。最常报告 的障碍是“因就诊时间安排带来的挑战”（45%的患者）、“抑郁”（29%）和“交通及机会成本”（）。聚类分析识别出六个患者亚群，每个亚群受到不同组别的障碍影响，且在患者特征方面存在差异。
ABQ-IVT是一种实用且可靠的工具，可用于识别患者特异性的IVT治疗依从性障碍。在实践中，该问卷可能有助于评估个体患者是否因特定的依从性障碍而有更高的NA风险。除了提高认识外，这还能实现更早的干预，尽管这些干预仍需验证。患者亚群面临不同的障碍，因此可能需要不同的预防护理。
