Istituti Clinici Zucchi Spa, Monza, Italy
Università degli Studi di Milano, Milano, Italy.
BMJ Open. 2024 May 9;14(5):e078431. doi: 10.1136/bmjopen-2023-078431.
To investigate the time course of medication adherence and some of the factors involved in this process in undocumented migrants with chronic diseases.
Retrospective cohort study.
A big non-governmental organisation in Milano, Italy, giving medical assistance to undocumented migrants.
1918 patients, 998 females and 920 males, with at least one chronic condition (diabetes, cardiovascular diseases (CVDs), mental health disorders) seen over a period of 10 years (2011-2020). Their mean age was 49.2±13 years.
Adherence to medications decreased over 1 year in all patients. This was more evident during the first 2 months of treatment. Patients on only one medication were less adherent than those on more than one medication; at 6 months the percentage of patients with high adherence was 33% vs 57% (p<0.0001) for diabetes, 15% vs 46% (p<0.0001) for mental disorders and 35% vs 59% (p<0.0001) for CVDs. Patients with mental disorders had the lowest adherence: 25% at 6 months and 3% at 1 year. Mental disorders, when present as comorbidities, greatly reduced the probability of being highly adherent: risk ratio (RR) 0.72 (95% CI 0.57 to 0.91; p=0.006) at 3 months, RR 0.77, (95% CI 0.59 to 1.01; p=0.06) at 6 months, RR 0.35 (95% CI 0.13 to 0.94; p=0.04) at 1 year. This was especially evident for patients with CVDs, whose percentage of high adherents decreased to 30% (p=0.0008) at 6 months and to 3% (p=0.01) at 1 year. We also noted that highly adherent patients usually were those most frequently seen by a doctor.
Interventions to increase medication adherence of undocumented migrants with chronic diseases are necessary, particularly in the first 2 months after beginning treatment. These should be aimed at people-centred care and include more outpatient consultations. Educational interventions should especially be taken into consideration for patients on monotherapy.
调查无证移民慢性病患者在治疗过程中的用药依从性及其相关因素的时间进程。
回顾性队列研究。
意大利米兰的一个大型非政府组织，为无证移民提供医疗援助。
1918 名患者，998 名女性和 920 名男性，在 10 年期间（2011-2020 年）至少患有一种慢性病（糖尿病、心血管疾病（CVD）、精神健康障碍）。他们的平均年龄为 49.2±13 岁。
所有患者的药物依从性在 1 年内逐渐下降。在治疗的头 2 个月更为明显。仅服用一种药物的患者比服用多种药物的患者更不依从；6 个月时，高依从性患者的百分比为糖尿病 33% vs 57%（p<0.0001）、精神障碍 15% vs 46%（p<0.0001）和 CVD 35% vs 59%（p<0.0001）。患有精神障碍的患者依从性最低：6 个月时为 25%，1 年时为 3%。当精神障碍作为合并症存在时，大大降低了高度依从的可能性：3 个月时风险比（RR）0.72（95%CI 0.57 至 0.91；p=0.006），6 个月时 RR 0.77（95%CI 0.59 至 1.01；p=0.06），1 年时 RR 0.35（95%CI 0.13 至 0.94；p=0.04）。对于患有 CVD 的患者，这种情况尤其明显，其高依从性患者的百分比在 6 个月时降至 30%（p=0.0008），在 1 年时降至 3%（p=0.01）。我们还注意到，高度依从的患者通常是那些接受医生就诊最频繁的患者。
需要对患有慢性病的无证移民进行增加药物依从性的干预措施，特别是在开始治疗后的头 2 个月。这些措施应针对以人为本的护理，并包括更多的门诊咨询。应特别考虑对单药治疗的患者进行教育干预。
