Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany.
Department of Research Methods in the Health Sciences, Institute of Everyday Culture, Sports and Health, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.
BMC Health Serv Res. 2022 May 2;22(1):588. doi: 10.1186/s12913-022-07987-3.
Based on the theoretical model of medication adherence (WHO, 2003), the aims of the study were (1) to develop and test a theory-based multidimensional model for the predictive power of barriers to and facilitators of medication adherence and (2) to identify the mediating effects of barriers to medication adherence on drug-related patient outcomes (barrier "MedAd- ": forget; facilitator "MedAd + ": regular intake).
Within a cross-sectional study entitled "Increasing medication adherence to improve patient safety in cardiological rehabilitation (PaSiMed)", the model was evaluated in structural analytical terms based on data collected online of N = 225 patients with cardiometabolic diseases. The revised "Freiburg questionnaire on medication adherence (FF-MedAd-R)" was used to measure the latent constructs (e.g., facilitator: communication; barrier: reservations)."
The structural equation model proved to exhibit an appropriate data fit (RMSEA: .05; CFI: .92). For all first-order facilitators of medication adherence, a high proportion of variance (62-94%) could be explained by the second-order factor "Physician-patient relationship (PPR)". All paths from "PPR" to the constructs depicting barriers to medication adherence showed significant negative effects. Facilitators ("MedAd + ") and barriers ("MedAd-") accounted for 20% and 12% of the variance, respectively, in global items of medication adherence. Whereas "Carelessness" showed a full mediation for "MedAd-", ''Reservations'' showed a partial mediation for "MedAd + ".
"PPR" is an important predictor of patient medication adherence. The results underline the importance of a trustful physician-patient relationship in reducing barriers and enhancing medication adherence.
基于药物依从性理论模型（WHO，2003 年），本研究的目的是（1）开发和测试一个基于理论的多维模型，以预测药物依从性的障碍和促进因素，（2）确定药物依从性障碍对药物相关患者结局的中介效应（障碍“MedAd-”：遗忘；促进因素“MedAd+”：规律摄入）。
在一项名为“提高药物依从性以提高心血管康复患者安全（PaSiMed）”的横断面研究中，根据在线收集的 225 名患有心脏代谢疾病患者的数据，从结构分析角度评估了该模型。使用修订后的“弗莱堡药物依从性问卷（FF-MedAd-R）”来测量潜在结构（例如，促进因素：沟通；障碍：保留意见）。
结构方程模型显示出适当的数据拟合（RMSEA：.05；CFI：.92）。对于所有促进药物依从性的一阶因素，二阶因素“医患关系（PPR）”可以解释高达 62-94%的方差。PPR 到药物依从性障碍结构的所有路径都显示出显著的负效应。促进因素（“MedAd+”）和障碍（“MedAd-”）分别解释了药物依从性总体项目的 20%和 12%的方差。虽然“粗心大意”完全中介了“MedAd-”，但“保留意见”部分中介了“MedAd+”。
“PPR”是患者药物依从性的重要预测因素。研究结果强调了建立信任的医患关系在减少障碍和提高药物依从性方面的重要性。
