Wells Joshua, Wang Chao, Dolgin Kevin, Kayyali Reem
Department of Pharmacy, Kingston University, Kingston upon Thames, KT1 2EE, UK.
Faculty of Health, Science, Social Care and Education, Kingston University, Kingston upon Thames, KT2 7LB, UK.
Patient Prefer Adherence. 2023 Feb 19;17:441-455. doi: 10.2147/PPA.S397424. eCollection 2023.
Poor medication adherence (MA) is linked to an increased likelihood of hospital admission. Early interventions to address MA may reduce this risk and associated health-care costs. This study aimed to evaluate a holistic Patient Reported Outcome Measure (PROM) of MA, known as SPUR, as a predictor of general admission and early readmission in patients living with Type 2 Diabetes.
An observational study design was used to assess data collected over a 12-month period including 6-month retrospective and 6-month prospective monitoring of the number of admissions and early readmissions (admissions occurring within 30 days of discharge) across the cohort. Patients (n = 200) were recruited from a large South London NHS Trust. Covariates of interest included: age, ethnicity, gender, level of education, income, the number of medicines and medical conditions, and a Covid-19 diagnosis. A Poisson or negative binomial model was employed for count outcomes, with the exponentiated coefficient indicating incident ratios (IR) [95% CI]. For binary outcomes (Coefficient, [95% CI]), a logistic regression model was developed.
Higher SPUR scores (increased adherence) were significantly associated with a lower number of admissions (IR = 0.98, [0.96, 1.00]). The number of medical conditions (IR = 1.07, [1.01, 1.13]), age ≥80 years (IR = 5.18, [1.01, 26.55]), a positive Covid-19 diagnosis during follow-up (IR = 1.83, [1.11, 3.02]) and GCSE education (IR = 2.11, [1.15,3.87]) were factors associated with a greater risk of admission. When modelled as a binary variable, only the SPUR score (-0.051, [-0.094, -0.007]) was significantly predictive of an early readmission, with patients reporting higher SPUR scores being less likely to experience an early readmission.
Higher levels of MA, as determined by SPUR, were significantly associated with a lower risk of general admissions and early readmissions among patients living with Type 2 Diabetes.
药物治疗依从性差与住院可能性增加有关。针对药物治疗依从性的早期干预措施可能会降低这种风险以及相关的医疗保健成本。本研究旨在评估一种全面的患者报告结局指标（PROM）——称为SPUR，作为2型糖尿病患者总体住院和早期再入院的预测指标。
采用观察性研究设计，评估在12个月期间收集的数据，包括对队列中住院和早期再入院（出院后30天内发生的住院）次数进行6个月的回顾性和6个月的前瞻性监测。患者（n = 200）从伦敦南部一家大型国民保健服务信托基金招募。感兴趣的协变量包括：年龄、种族、性别、教育程度、收入、药物数量和医疗状况，以及新冠病毒病诊断。计数结局采用泊松或负二项式模型，指数系数表示发病率比（IR）[95%置信区间]。对于二元结局（系数，[95%置信区间]），建立了逻辑回归模型。
较高的SPUR评分（依从性增加）与较低的住院次数显著相关（IR = 0.98，[0.96，1.00]）。医疗状况数量（IR = 1.07，[1.01，1.13]）、年龄≥80岁（IR = 5.18，[1.01，26.55]）、随访期间新冠病毒病诊断呈阳性（IR = 1.83，[1.11，3.02]）以及普通中等教育证书（GCSE）教育程度（IR = 2.11，[1.15，3.87]）是与住院风险增加相关的因素。当作为二元变量建模时，只有SPUR评分（-0.051，[-0.094，-0.007]）能显著预测早期再入院，报告SPUR评分较高的患者早期再入院的可能性较小。
由SPUR确定的较高水平的药物治疗依从性与2型糖尿病患者总体住院和早期再入院风险较低显著相关。
