Achterbosch Maria, Vart Priya, van Dijk Liset, van Boven Job F M
Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands.
Front Pharmacol. 2023 Oct 25;14:1283135. doi: 10.3389/fphar.2023.1283135. eCollection 2023.
Medication adherence to inhalation medication is suboptimal in patients with COPD and asthma. Shared decision making (SDM) is proposed as an intervention to improve medication adherence. Despite its wide promotion, evidence of SDM's association with greater medication adherence is scarce. Also, it is unknown to what degree patients presently experience SDM and how it is associated with medication adherence. To (i) assess the level of SDM and (ii) medication adherence, (iii) explore the relation between SDM and medication adherence and iv) investigate possible underlying mechanisms. Cross-sectional observational study. A survey was distributed among Dutch patients with COPD and/or asthma using inhaled medication. Medication adherence was measured using the Test of Adherence to Inhalers (TAI-10), and SDM by the 9-item Shared Decision-Making questionnaire (SMD-Q-9). Feeling of competence, relatedness and feeling of autonomy from the Self-Determination Theory (SDT) were considered as possible mechanisms. The primary outcome was adherence. A total of 396 patients with complete information on relevant covariates were included. Mean SDM-Q-9 score was 26.7 (SD 12.1, range 0-45) and complete adherence was 41.2%. The odds ratio for the association of SDM with adherence was 1.01 (95% CI: 0.99, 1.02). This only changed minimally when adjusted for mediators (mediating effect <3%). The patient experienced level of SDM in daily practice and medication adherence have room for improvement. No association between SDM and medication adherence was observed. Factors related to feeling of competence, relatedness and feeling of autonomy did not meaningfully explain this finding.
慢性阻塞性肺疾病（COPD）和哮喘患者对吸入药物的依从性欠佳。共享决策（SDM）被提议作为一种改善药物依从性的干预措施。尽管其得到广泛推广，但关于SDM与更高药物依从性之间关联的证据却很少。此外，目前患者体验SDM的程度以及它与药物依从性如何关联尚不清楚。目的是（i）评估SDM水平和（ii）药物依从性，（iii）探索SDM与药物依从性之间的关系，以及（iv）调查可能的潜在机制。横断面观察性研究。对荷兰使用吸入药物的COPD和/或哮喘患者进行了一项调查。使用吸入器依从性测试（TAI - 10）测量药物依从性，通过9项共享决策问卷（SMD - Q - 9）测量SDM。自我决定理论（SDT）中的能力感、关联性和自主感被视为可能的机制。主要结局是依从性。共纳入396例具有相关协变量完整信息的患者。SDM - Q - 9平均得分为26.7（标准差12.1，范围0 - 45），完全依从率为41.2%。SDM与依从性关联的比值比为1.01（95%置信区间：0.99，1.02）。在对中介变量进行调整后，这一结果仅略有变化（中介效应<3%）。患者在日常实践中体验到的SDM水平和药物依从性都有改善空间。未观察到SDM与药物依从性之间的关联。与能力感、关联性和自主感相关的因素并不能有效解释这一发现。
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