Courtet Philippe, Pecout Catherine, Lainé-Pellet Anne-Félice, Chekroun Michael, Avril Charlotte, Mourad Jean-Jacques
Service d'Urgence et Post-Urgence Psychiatrique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
Viatris, Pfizer Inc France, Paris, France.
JMIR Form Res. 2022 Mar 16;6(3):e32725. doi: 10.2196/32725.
Noncommunicable disease (NCD)-related deaths account for 71% of deaths worldwide. The World Health Organization recently developed a global action plan to address the impact of NCDs, with the goal of reducing the number of premature NCD-related deaths to 25% by the year 2025. Appropriate therapeutic adherence is critical for effective disease management; however, approximately 30%-50% of patients with an NCD do not comply with disease management activities as prescribed. Web-based patient communities can represent platforms from which specific information on patients' perception of treatment adherence can be gathered outside of a clinical trial setting.
This study aims to better understand patients' perspectives regarding therapeutic adherence and iatrogenic risk in 2 major groups of NCDs for which poor disease management can have fatal consequences: cardiovascular diseases and mental disorders. Therapeutic adherence, motivational factors, patients' awareness and perception of iatrogenesis, and treatment tools used by patients were assessed.
A web-based survey was performed among patients with cardiovascular diseases or mental disorders or both conditions who were registered on the French Carenity platform, a web-based community in which patients with an NCD can share experiences and receive support and information. The study inclusion criteria were defined as follows: diagnosis of cardiovascular disease or mental disorder or both conditions (self-declared), age ≥18 years, residence in France, registration on the French Carenity platform, and ongoing pharmaceutical treatment for the condition. Patients who met the inclusion criteria were then invited to complete a self-administered web-based questionnaire that included questions addressing therapeutic adherence and iatrogenic risk.
A total of 820 patients were enrolled in the study, including patients with cardiovascular diseases (403/820, 49.2%), patients with mental disorders (292/820, 35.6%), and patients with both cardiovascular diseases and mental disorders (125/820, 15.2%). The mean age of the participants was 55.2 (SD 12.7) years. We found that 82.8% (679/820) of patients experienced adverse effects of medication. Patients tended to perceive themselves to be more adherent than they actually were; a significant number of patients disregarded their prescription and stopped or interrupted medication without consulting with a doctor. Patients with cardiovascular diseases were nearly twice as adherent as patients with a mental disorder (P≤.001). Adherence was significantly associated with gender (P≤.001), age (P≤.001), and treatment complexity (P≤.001). Finally, for each disease type, 3 patient profiles were identified, which provide interesting insight for improving therapeutic adherence and adjustment strategies specifically according to patient behavior.
This study provides insight into the perspectives of patients receiving therapy for cardiovascular diseases or mental disorders or both conditions, which could help improve the management of NCDs and prevent premature death. Our study also shows that web-based patient platforms provide new opportunities to improve disease management by understanding patients' experiences.
非传染性疾病（NCD）相关死亡占全球死亡人数的71%。世界卫生组织最近制定了一项全球行动计划，以应对非传染性疾病的影响，目标是到2025年将非传染性疾病相关过早死亡人数减少25%。适当的治疗依从性对于有效的疾病管理至关重要；然而，约30%-50%的非传染性疾病患者未按规定进行疾病管理活动。基于网络的患者社区可以成为在临床试验环境之外收集有关患者治疗依从性认知的特定信息的平台。
本研究旨在更好地了解两类主要非传染性疾病患者对治疗依从性和医源性风险的看法，这两类疾病若管理不善可能会导致致命后果，即心血管疾病和精神障碍。评估了治疗依从性、动机因素、患者对医源性疾病的认识和认知以及患者使用的治疗工具。
对在法国Carenity平台注册的患有心血管疾病或精神障碍或两者皆有的患者进行了一项基于网络的调查，该平台是一个非传染性疾病患者可以分享经验并获得支持和信息的网络社区。研究纳入标准定义如下：心血管疾病或精神障碍或两者皆有的诊断（自我申报）、年龄≥18岁、居住在法国、在法国Carenity平台注册以及正在接受该疾病的药物治疗。符合纳入标准的患者随后被邀请完成一份基于网络的自填问卷，其中包括有关治疗依从性和医源性风险的问题。
共有820名患者纳入研究，包括心血管疾病患者（403/820，49.2%）、精神障碍患者（292/820，35.6%）以及心血管疾病和精神障碍均有的患者（125/820，15.2%）。参与者的平均年龄为55.2（标准差12.7）岁。我们发现82.8%（679/820）的患者经历了药物不良反应。患者倾向于认为自己比实际情况更依从；相当多的患者无视处方，在未咨询医生的情况下停止或中断用药。心血管疾病患者的依从性几乎是精神障碍患者的两倍（P≤0.001）。依从性与性别（P≤0.001）、年龄（P≤0.001）和治疗复杂性（P≤0.001）显著相关。最后，针对每种疾病类型，确定了3种患者类型，这为根据患者行为改善治疗依从性和调整策略提供了有趣的见解。
本研究深入了解了接受心血管疾病或精神障碍或两者治疗的患者的观点，这有助于改善非传染性疾病的管理并预防过早死亡。我们的研究还表明，基于网络的患者平台通过了解患者的经历为改善疾病管理提供了新机会。
