Reach Gérard, Calvez Aurélie, Sritharan Nanthara, Boubaya Marouane, Lévy Vincent, Sidorkiewicz Stéphanie, Fiani May
Health Education and Promotion Laboratory (LEPS UR 3412), Sorbonne Paris Nord University, 74 rue Marcel Cachin 93017, Bobigny Cedex, France.
Department of General Practice, University of Picardy Jules Verne, Amiens, France.
Drugs Real World Outcomes. 2023 Jun;10(2):309-320. doi: 10.1007/s40801-023-00361-7. Epub 2023 Mar 30.
Among the determinants of nonadherence, polypharmacy (common in people with multiple pathologies and especially in elderly patients), plays a major role.
In patients who are subject to polypharmacy involving different classes of medications, the first aim is to assess the impact of medication importance given by patients on (i) medication adherence and (ii) the respective effect of intentionality and habit in medication importance and medication adherence. The second objective is to compare the importance given to medication and adherence in the different therapeutic classes.
Patients taking 5-10 different medications for at least 1 month were included in a cross-sectional survey in three private practices in one region in France.
This study included 130 patients (59.2 % female) with 851 medications in total. The mean ± standard deviation (SD) age was 70.5 ± 12.2 years. The mean ± SD of medications taken was 6.9 ± 1.7. Treatment adherence had a strong positive correlation with the patient-perceived medication importance (p < 0.001). Counter-intuitively, taking a large number of medications (≥7) was associated with being fully adherent (p = 0.02). A high intentional nonadherence score was negatively associated with high medication importance (p = 0.003). Furthermore, patient-perceived medication importance was positively associated with taking treatment by habit (p = 0.03). Overall nonadherence more strongly correlated with unintentional nonadherence (p < 0.001) than with intentional nonadherence (p = 0.02). Compared to the antihypertensive class, a decrease in adherence by medication was observed in psychoanaleptics (p < 0.0001) and drugs used in diabetes class (p = 0.002), and a decrease in importance in lipid-modifying agents class (p = 0.001) and psychoanaleptics (p < 0.0001).
The perception of the importance of a medicine is associated with the place of intentionality and habit in patient adherence. Therefore, explaining the importance of a medicine should become an important part of patient education.
在导致不依从的因素中，多重用药（在患有多种疾病的人群中很常见，尤其是老年患者）起着主要作用。
在接受涉及不同类别药物的多重用药治疗的患者中，首要目标是评估患者对药物重要性的认知对（i）药物依从性以及（ii）药物重要性和药物依从性中意向性和习惯各自影响的作用。第二个目标是比较不同治疗类别中药物重要性和依从性的认知情况。
在法国一个地区的三家私人诊所开展的一项横断面调查中，纳入了服用5 - 10种不同药物至少1个月的患者。
本研究纳入了130名患者（59.2%为女性），共涉及851种药物。平均年龄±标准差为70.5±12.2岁。平均服用药物数量±标准差为6.9±1.7种。治疗依从性与患者感知的药物重要性呈强正相关（p < 0.001）。与直觉相反，服用大量药物（≥7种）与完全依从相关（p = 0.02）。高意向性不依从评分与高药物重要性呈负相关（p = 0.003）。此外，患者感知的药物重要性与习惯性服药呈正相关（p = 0.03）。总体不依从与无意不依从的相关性更强（p < 0.001），而与有意不依从的相关性较弱（p = 0.02）。与抗高血压药物类别相比，精神振奋剂（p < 0.0001）和糖尿病类药物（p = 0.002）的药物依从性降低，而调脂药物类别（p = 0.001）和精神振奋剂（p < 0.0001）的药物重要性降低。
对药物重要性的认知与意向性和习惯在患者依从性中的地位相关。因此，解释药物的重要性应成为患者教育的重要组成部分。
