Department of Geriatrics, University Hospital Halle, Halle, Germany.
Department of Neurology, Jena University Hospital, Jena, Germany.
BMJ Open. 2023 Jan 25;13(1):e067326. doi: 10.1136/bmjopen-2022-067326.
Measuring the degree of adherence to medication is essential in healthcare However, the cut-offs provided for adherence scales are often arbitrary and disease-specific, and need to be validated against a clinical outcome. Here, we used health-related quality of life (QoL) to determine cut-offs for a self-report adherence questionnaire in patients with neurological diagnoses.
Cross-sectional study.
910 patients (age 70±8.6 years) with neurological disorders were recruited from the wards of neurology at a local university hospital. All patients received a comprehensive geriatric assessment, including assessments of adherence (Stendal Adherence to Medication Score, SAMS) and QoL (Short Form Survey SF-36).
The main aim of the study was to define a cut-off for non-adherence at which QoL is significantly impaired. Thus, we used Spearman's rank correlation, multivariate and univariate analyses of variance to test the impact of different adherence levels on QoL. Receiver operating characteristics and area under curve measures were then used to determine cut-off scores for adherence based on significant differences in QoL.
Correlations between SAMS and SF-36 domains were weak (ranging between r=-0.205 for emotional well-being and r=-0.094 for pain) and the effect of non-adherence on QoL disappeared in the multivariate analysis of variance (p=0.522) after adjusting for demographical and clinical factors. SAMS cut-offs in terms of SF-36 domains varied greatly, so that an overall SAMS cut-off for this cohort could not be defined.
QoL as measured by the SF-36 is not suitable as a single outcome parameter to study the impact of non-adherence on QoL in a mixed neurological cohort. Since both QoL and adherence are heterogeneous, multifaceted constructs, it is unlikely to find an overarching cut-off applicable for all patients. Thus, it may be necessary to use disease or cohort-specific external outcome parameters to measure the indirect effect of interventions to enhance adherence.
DRKS00016774.
衡量药物依从性的程度在医疗保健中至关重要。然而，用于衡量药物依从性的量表的截断值通常是任意的，并且是针对特定疾病的，需要针对临床结果进行验证。在这里，我们使用健康相关的生活质量（QoL）来确定神经诊断患者自我报告的依从性问卷的截断值。
横断面研究。
从当地大学医院神经科病房招募了 910 名患有神经障碍的患者（年龄 70±8.6 岁）。所有患者都接受了全面的老年评估，包括对依从性（Stendal 药物依从性评分，SAMS）和生活质量（短格式调查 SF-36）的评估。
研究的主要目的是定义一个依从性的截断值，在此值下生活质量会显著受损。因此，我们使用 Spearman 等级相关、多元和单因素方差分析来测试不同依从性水平对生活质量的影响。然后使用接收者操作特征和曲线下面积测量来确定基于生活质量显著差异的依从性的截断分数。
SAMS 与 SF-36 各领域之间的相关性较弱（范围从情感健康的 r=-0.205 到疼痛的 r=-0.094），并且在调整人口统计学和临床因素后，非依从性对 QoL 的影响在多元方差分析中消失（p=0.522）。SF-36 各领域的 SAMS 截断值差异很大，因此无法为该队列定义总体 SAMS 截断值。
生活质量作为 SF-36 的衡量标准不适合作为单一的结果参数来研究非依从性对混合神经队列中生活质量的影响。由于生活质量和依从性都是异质的、多方面的结构，因此不太可能找到适用于所有患者的总体截断值。因此，可能有必要使用特定疾病或队列的外部结果参数来衡量干预措施提高依从性的间接效果。
DRKS00016774。
