青少年慢性肾脏病患者的药物依从性：成功的习惯。
Medication adherence in youths with CKD: habits for success.
机构信息
Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA.
出版信息
Pediatr Nephrol. 2023 Nov;38(11):3791-3802. doi: 10.1007/s00467-023-05976-0. Epub 2023 Jun 12.
BACKGROUND
Poor adherence habits are key contributors to nonadherence but there are few clinically feasible methods for evaluating adherence habits, particularly for youths with chronic kidney disease (CKD). This study investigated how participants' qualitative responses to three interview questions about adherence habits mapped to primary principles of habit formation and objectively measured medication adherence in youths with CKD.
METHODS
Participants (ages 11-21 years) were recruited from a pediatric nephrology clinic as part of a larger study. Participants' daily objective antihypertensive medication adherence was measured with an electronic pill bottle over a 4-week baseline period. Qualitative interviews about adherence habits and routines were conducted with a subset of participants (N = 18).
RESULTS
Clear qualitative differences emerged in how participants with high-medium adherence (80-100%) discussed adherence habits compared to participants with low adherence (0-79%). Participants with high-medium adherence discussed situational cues for taking medicine, including locations that cue adherence, step-by-step events leading up to taking medicine, and people who cue adherence. Participants with high-medium adherence regularly described taking medicine as "automatic," "second nature," and a "habit." Participants with low adherence rarely discussed these habit features nor did they explicitly acknowledge currently missing doses. Participants with low adherence tended to discuss challenges with organization and routines for taking medicine.
CONCLUSIONS
Evaluating patient responses to questions about adherence habits may uncover challenges with adherence habit formation, provide direction for habit-strengthening intervention focused on developing automatic cues for taking medication, and support adherence successes for youths with CKD.
CLINICAL TRIAL REGISTRATION NUMBER
NCT03651596. A higher resolution version of the Graphical abstract is available as Supplementary information.
背景
依从性差的习惯是导致不依从的主要原因，但目前很少有临床可行的方法来评估依从性习惯，尤其是对于患有慢性肾脏病（CKD）的青少年。本研究探讨了参与者对三个关于依从性习惯的访谈问题的定性反应如何与习惯形成的主要原则相对应，并在患有 CKD 的青少年中客观测量药物依从性。
方法
参与者（年龄 11-21 岁）从儿科肾病诊所招募，作为一项更大研究的一部分。参与者的日常客观降压药物依从性在 4 周基线期内通过电子药瓶进行测量。对一小部分参与者（N=18）进行了关于依从性习惯和常规的定性访谈。
结果
与低依从性（0-79%）参与者相比，高-中依从性（80-100%）参与者在讨论依从性习惯时出现了明显的定性差异。高-中依从性的参与者讨论了服药的情境线索，包括提示服药的地点、服药前的逐步事件以及提示服药的人。高-中依从性的参与者经常将服药描述为“自动”、“自然而然”和“习惯”。低依从性的参与者很少讨论这些习惯特征，也没有明确承认目前漏服的剂量。低依从性的参与者倾向于讨论在组织和常规服药方面的挑战。
结论
评估患者对依从性习惯问题的反应可能会发现与依从性习惯形成相关的挑战，为针对药物服用自动提示的习惯强化干预提供方向，并为患有 CKD 的青少年提供依从性成功的支持。
临床试验注册号
NCT03651596。图形摘要的高分辨率版本可作为补充信息提供。
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