炎症性肠病患者从儿科到成人的过渡及药物依从性
Pediatric-to-adult Transition and Medication Adherence in Patients with Inflammatory Bowel Disease.
作者信息
Jeganathan Jayson, Lee Cheng Hiang, Rahme Antony, Tiao Darren K, Weston Celine, Dutt Shoma, Magoffin Annabel, Kwan Vu, Alswaifi Aladdin, Katelaris Peter H, Gaskin Kevin J, OʼLoughlin Edward V, Leong Rupert W
机构信息
*Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; †Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; ‡James Fairfax Institute of Paediatric Clinical Nutrition, The University of Sydney, Sydney, New South Wales, Australia; §IBD Sydney Organisation, Sydney, New South Wales, Australia; ‖Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; ¶Gastroenterology and Liver Services, Concord General Hospital, Sydney, New South Wales, Australia; and **Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.
出版信息
Inflamm Bowel Dis. 2017 Jul;23(7):1065-1070. doi: 10.1097/MIB.0000000000001114.
BACKGROUND
Medication nonadherence is common in inflammatory bowel disease and is associated with poor outcomes. There has been no study on pediatric-to-adult transition as a risk factor for nonadherence in inflammatory bowel disease, which has been demonstrated in other diseases. We aimed to assess whether transitioned (TR) patients have higher nonadherence rates than young adults (YAs) diagnosed in adulthood.
METHODS
Consecutive ambulatory subjects were prospectively recruited and completed the validated Medication Adherence Reporting Scale (MARS), with the primary outcome being adherence differences between group age-matched TR and YA groups. Pediatric subjects were taken as the control group. Perceptions of medication-related necessity and concerns were assessed with the Beliefs about Medicines Questionnaire (BMQ). Nonadherers (defined as MARS ≤16) received the Inflammatory Bowel Diseases Pharmacist Adherence Counselling (IPAC) intervention and adherence change was reassessed after 6 months as a secondary outcome.
RESULTS
Adherence in TR patients (n = 38, mean age 20.4, 13.2% nonadherent) was noninferior to and numerically better than YAs diagnosed in adulthood (n = 41, mean age 21.2, 24.4%). Nonadherence in the pediatric control group (n = 50, mean age 14.7) was 8.0%. YAs had significantly higher medication-related concerns (14.6 versus 11.9, P = 0.02) than the pediatric group. The IPAC intervention reduced nonadherence rates by 60% (P = 0.004).
CONCLUSIONS
TR patients did not have worse adherence than YAs diagnosed in adulthood. Protective factors may include previous treatment in pediatric centers and the salient symptomatology of inflammatory bowel disease, whereas increasing concerns over medications contribute to nonadherence in YAs. Pharmacist-led counselling improves adherence in these patients.
背景
药物治疗依从性不佳在炎症性肠病中很常见，且与不良预后相关。在炎症性肠病中，尚未有研究将从儿科到成人的转变作为治疗依从性不佳的风险因素，而在其他疾病中已有相关研究证实。我们旨在评估已完成转变（TR）的患者与成年期确诊的年轻成人（YA）相比，是否具有更高的治疗不依从率。
方法
前瞻性招募连续的门诊受试者，并完成经过验证的药物治疗依从性报告量表（MARS），主要结局是年龄匹配的TR组和YA组之间的依从性差异。儿科受试者作为对照组。使用药物信念问卷（BMQ）评估对药物相关必要性和担忧的认知。不依从者（定义为MARS≤16）接受炎症性肠病药剂师依从性咨询（IPAC）干预，并在6个月后重新评估依从性变化作为次要结局。
结果
TR组患者（n = 38，平均年龄20.4岁，13.2%为不依从者）的依从性不低于成年期确诊的YA组（n = 41，平均年龄21.2岁，24.4%），且在数值上更好。儿科对照组（n = 50，平均年龄14.7岁）的不依从率为8.0%。YA组与儿科组相比，与药物相关的担忧显著更高（14.6对11.9，P = 0.02）。IPAC干预使不依从率降低了60%（P = 0.004）。
结论
TR组患者的依从性并不比成年期确诊的YA组差。保护因素可能包括先前在儿科中心的治疗以及炎症性肠病明显的症状，而对药物越来越多的担忧导致YA组治疗不依从。药剂师主导的咨询可提高这些患者的依从性。
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