Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Lupus. 2024 May;33(6):615-628. doi: 10.1177/09612033241242692. Epub 2024 Mar 28.
To identify determinants of medication non-adherence in a Swedish population of systemic lupus erythematosus (SLE).
Patients with SLE from Karolinska and Örebro University Hospitals participated in a survey-based cross-sectional study. Demographics, disease activity, organ damage, HRQoL (LupusQol, EQ-5D-5 L), medication non-adherence (<80% on CQR-19 or MASRI) and beliefs about medicines (BMQ) were registered. MASRI was used to report adherence to different drugs/drug classes, categorised into (i) antimalarial agents (AMA), (ii) glucocorticoids and (iii) other SLE medications. Multivariable logistic regression adjusted for age, sex, disease activity and organ damage.
Among 205 respondents, the median age was 52.0 years (IQR: 34.0-70.0), 86.3% were women, 66.8% were non-adherent to their medications according to CQR-19, and 6.6% and 6.3% were non-adherent to AMA and glucocorticoids, respectively, according to MASRI. Positive beliefs about glucocorticoids (OR; 95% CI: 0.77; 0.59-0.99; = .039) and medications overall (0.71; 0.52-0.97; = .029) were protective against non-adherence to glucocorticoids. Anxiety/depression (3.09; 1.12-8.54; = .029), medication concerns (1.12; 1.05-1.20; < .001) and belief that medications are overused (1.30; 1.15-1.46; < .001) or harmful (1.36; 1.19-1.56; < .001) were associated with medication non-adherence (CQR-19); beliefs in the necessity of medications (0.73; 0.65-0.82; < .001) and positive beliefs in medications were protective (0.72; 0.60-0.86; < .001). No associations were found between other investigated factors and medication non-adherence.
Beliefs about medications were a major determinant of medication non-adherence. Patient education may help alleviate the negative impact of misinformation/unawareness on adherence.
确定瑞典系统性红斑狼疮（SLE）患者药物治疗不依从的决定因素。
来自卡罗林斯卡和厄勒布鲁大学医院的 SLE 患者参加了一项基于调查的横断面研究。登记了人口统计学、疾病活动、器官损伤、HRQoL（狼疮 QoL、EQ-5D-5L）、药物治疗不依从（CQR-19 或 MASRI ＜80%）和药物信念（BMQ）。MASRI 用于报告不同药物/药物类别的依从性，分为（i）抗疟药物（AMA），（ii）糖皮质激素和（iii）其他 SLE 药物。多变量逻辑回归调整了年龄、性别、疾病活动和器官损伤。
在 205 名受访者中，中位年龄为 52.0 岁（IQR：34.0-70.0），86.3%为女性，根据 CQR-19，66.8%的患者药物治疗不依从，根据 MASRI，分别有 6.6%和 6.3%的患者不依从 AMA 和糖皮质激素。对糖皮质激素的正面信念（比值比；95%可信区间：0.77；0.59-0.99； =.039）和对整体药物的正面信念（0.71；0.52-0.97； =.029）是糖皮质激素治疗不依从的保护因素。焦虑/抑郁（3.09；1.12-8.54； =.029）、药物担忧（1.12；1.05-1.20； <.001）和认为药物过度使用（1.30；1.15-1.46； <.001）或有害（1.36；1.19-1.56； <.001）的信念与药物治疗不依从（CQR-19）相关；对药物必要性的信念（0.73；0.65-0.82； <.001）和对药物的正面信念是保护因素（0.72；0.60-0.86； <.001）。未发现其他研究因素与药物治疗不依从之间存在关联。
对药物的信念是药物治疗不依从的主要决定因素。患者教育可能有助于减轻错误信息/无知对依从性的负面影响。
