北美两家诊所常规HIV护理中通过患者报告结局评估确定的依从性欠佳的风险因素。
Risk Factors for Suboptimal Adherence Identified by Patient-Reported Outcomes Assessments in Routine HIV Care at 2 North American Clinics.
作者信息
Short Duncan, Wang Xueqi, Suri Shivali, Hsu Thomas K, Jones Bryn, Fredericksen Rob J, Crane Heidi M, Musten Alexandra, Bacon Jean, Wang Yongwei, Gough Kevin A, Ramgopal Moti, Berry Jeff, Lober William B
机构信息
ViiV Healthcare, Brentford, UK.
ViiV Healthcare, Durham, NC, USA.
出版信息
Patient Prefer Adherence. 2022 Sep 5;16:2461-2472. doi: 10.2147/PPA.S378335. eCollection 2022.
PURPOSE
Use of patient-reported outcomes assessments (PROs) can improve patient-provider communication and focus provider attention on current health issues. This analysis examines the association between suboptimal antiretroviral therapy (ART) adherence and factors obtained through PROs among people with HIV (PWH) at 2 North American outpatient clinics.
PATIENTS AND METHODS
Immediately before a clinic visit, PWH completed self-administered PROs. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models to identify sociodemographic and health-related factors (satisfaction with ART, difficulty meeting housing costs, depression, intimate partner violence, risk of malnutrition, smoking status, alcohol use, and substance use) associated with suboptimal adherence (defined as self-reporting <95% or <80% adherence). Multiple imputation was performed to account for missing data in the multivariate analyses.
RESULTS
Of 1632 PWH, 1239 (76%) responded to the adherence assessment; of these, 268 (22%) and 106 (9%) reported <95% and <80% adherence, respectively. Of 1580 PWH who responded, 354 (22%) were dissatisfied with their HIV medication. Of responding PWH, 19% reported moderate-to-severe depression, 23% indicated they were at risk of malnutrition, 34% were current smokers, and 62% reported substance use in the past 3 months. Dissatisfaction with ART was significantly associated with <95% and <80% adherence in the unadjusted analysis (unadjusted OR [95% CI], 3.38 [2.51-4.56] and 4.26 [2.82-6.42], respectively) and adjusted analysis (adjusted OR [95% CI], 2.76 [1.91-4.00] and 3.28 [1.95-5.52], respectively); significance remained after multiple imputation. In adjusted analyses, no risk of malnutrition was significantly associated with reduced odds of <95% adherence after multiple imputation (adjusted OR [95% CI], 0.714 [0.511-0.997]); no other factors were associated with <95% or <80% adherence.
CONCLUSION
These results suggest that implementation of PROs evaluating treatment satisfaction may provide value to adherence management in routine HIV care.
目的
使用患者报告的结局评估（PROs）可以改善患者与医疗服务提供者之间的沟通，并使医疗服务提供者将注意力集中在当前的健康问题上。本分析研究了北美两家门诊诊所中，接受抗逆转录病毒治疗（ART）的患者依从性欠佳与通过PROs获得的因素之间的关联。
患者与方法
在门诊就诊前，接受抗逆转录病毒治疗的患者完成自行填写的PROs。通过逻辑回归模型估计未调整和调整后的比值比（ORs）及95%置信区间（CIs），以确定与依从性欠佳（定义为自我报告依从性<95%或<80%）相关的社会人口统计学和健康相关因素（对ART的满意度、支付住房成本困难、抑郁、亲密伴侣暴力、营养不良风险、吸烟状况、饮酒及药物使用情况）。在多变量分析中采用多重填补法处理缺失数据。
结果
1632名接受抗逆转录病毒治疗的患者中，1239名（76%）对依从性评估做出了回应；其中，分别有268名（22%）和106名（9%）报告依从性<95%和<80%。在1580名做出回应的接受抗逆转录病毒治疗的患者中，354名（22%）对其HIV药物治疗不满意。在做出回应的接受抗逆转录病毒治疗的患者中，19%报告有中度至重度抑郁，23%表示有营养不良风险，34%为当前吸烟者，62%报告在过去3个月内有药物使用情况。在未调整分析中，对ART的不满与依从性<95%和<80%显著相关（未调整OR[95%CI]分别为3.38[2.51-4.56]和4.26[2.82-6.42]），在调整分析中也是如此（调整OR[95%CI]分别为2.76[1.91-4.00]和3.28[1.95-5.52]）；多重填补后仍具有显著性。在调整分析中，多重填补后，没有营养不良风险与依从性<95%的几率降低显著相关（调整OR[95%CI]为0.714[0.511-0.997]）；没有其他因素与依从性<95%或<80%相关。
结论
这些结果表明，实施评估治疗满意度的PROs可能对常规HIV护理中的依从性管理具有价值。
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