卒中与短暂性脑缺血发作幸存者药物治疗依从性的主要障碍。
Key barriers to medication adherence in survivors of strokes and transient ischemic attacks.
机构信息
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.
出版信息
J Gen Intern Med. 2013 May;28(5):675-82. doi: 10.1007/s11606-012-2308-x. Epub 2013 Jan 4.
BACKGROUND
Even though medications can greatly reduce the risk of recurrent stroke, medication adherence is suboptimal in stroke survivors.
OBJECTIVE
To identify key barriers to medication adherence in a predominantly low-income, minority group of stroke and transient ischemic attack (TIA) survivors.
DESIGN
Cross-sectional study.
PARTICIPANTS
Six hundred stroke or TIA survivors, age ≥ 40 years old, recruited from underserved communities in New York City.
MAIN MEASURES
Medication adherence was measured using the 8-item Morisky Medication Adherence Questionnaire. Potential barriers to adherence were assessed using validated instruments. Logistic regression was used to test which barriers were independently associated with adherence. Models were additionally controlled for age, race/ethnicity, income, and comorbidity.
KEY RESULTS
Forty percent of participants had poor self-reported medication adherence. In unadjusted analyses, compared to adherent participants, non-adherent participants had increased concerns about medications (26 % versus 7 %, p < 0.001), low trust in their personal doctor (42 % versus 29 %, p = 0.001), problems communicating with their doctor due to language (19 % versus 12 %, p = 0.02), perceived discrimination from the health system (42 % versus 22 %, p < 0.001), difficulty accessing health care (16 % versus 8 %, p = 0.002), and inadequate continuity of care (27 % versus 20 %, p = 0.05). In the fully adjusted model, only increased concerns about medications [OR 5.02 (95 % CI 2.76, 9.11); p < 0.001] and perceived discrimination [OR 1.85 (95 % CI 1.18, 2.90); p = 0.008] remained significant barriers.
CONCLUSIONS
Increased concerns about medications (related to worry, disruption, long-term effects, and medication dependence) and perceived discrimination were the most important barriers to medication adherence in this group. Interventions that reduce medication concerns have the greatest potential to improve medication adherence in low-income stroke/TIA survivors.
背景
尽管药物可以大大降低中风复发的风险，但中风幸存者的药物依从性并不理想。
目的
确定以低收入、少数族裔为主的中风和短暂性脑缺血发作（TIA）幸存者药物依从性的主要障碍。
设计
横断面研究。
参与者
从纽约市服务不足社区招募的 600 名年龄≥40 岁的中风或 TIA 幸存者。
主要措施
使用 8 项 Morisky 药物依从性问卷测量药物依从性。使用经过验证的工具评估药物依从性的潜在障碍。使用逻辑回归检验哪些障碍与依从性独立相关。模型还控制了年龄、种族/族裔、收入和合并症。
主要结果
40%的参与者自我报告药物依从性差。在未调整的分析中，与依从性参与者相比，不依从性参与者对药物的担忧增加（26%比 7%，p<0.001），对个人医生的信任度较低（42%比 29%，p=0.001），由于语言问题与医生沟通困难（19%比 12%，p=0.02），认为受到医疗系统的歧视（42%比 22%，p<0.001），获得医疗保健的难度增加（16%比 8%，p=0.002），以及医疗服务连续性不足（27%比 20%，p=0.05）。在完全调整的模型中，只有对药物的担忧增加[比值比 5.02（95%置信区间 2.76，9.11）；p<0.001]和感知歧视[比值比 1.85（95%置信区间 1.18，2.90）；p=0.008]仍然是药物依从性的重要障碍。
结论
在这组人群中，对药物的担忧增加（与担忧、干扰、长期影响和药物依赖有关）和感知歧视是药物依从性的最重要障碍。减少药物担忧的干预措施最有可能提高低收入中风/TIA 幸存者的药物依从性。
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