炎症性肠病未来不依从的临床预测因素。
Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease.
机构信息
1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; 3Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 4Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands; 5Department of Gastroenterology and Hepatology (Co-MIK), Zuyderland Medical Center, Heerlen, Sittard, Geleen, the Netherlands; 6Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, the Netherlands; 7Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands; 8Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; 9Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands; 10Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, the Netherlands; 11Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, the Netherlands; 12Department of Gastroenterology and Hepatology, Leiden University Medical Center, the Netherlands; 13Department of Gastroenterology and Hepatology, Maastricht University Medical Center, the Netherlands; 14Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands; 15Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands; and 16Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
出版信息
Inflamm Bowel Dis. 2017 Sep;23(9):1568-1576. doi: 10.1097/MIB.0000000000001201.
BACKGROUND
Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD.
METHODS
We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Data were collected by means of 3-monthly questionnaires on the course of disease and healthcare utilization. Medication adherence was assessed using a visual analogue scale, ranging from 0% to 100%. Levels <80% were considered to indicate nonadherence. The Brief Illness Perception Questionnaire was used to identify illness perceptions. We used a logistic regression analysis to identify patient- and disease-related factors predictive of nonadherence 3 months after the assessment of predictors.
RESULTS
In total, 1558 patients with CD and 1054 patients with UC were included and followed for 2.5 years. On average, 12.1% of patients with CD and 13.3% of patients with UC using IBD-specific medication were nonadherent. Nonadherence was most frequently observed in patients using mesalazine (CD), budesonide (UC) and rectally administrated therapy (both CD and UC). A higher perceived treatment control and understanding of the disease were associated with adherence to medical therapy. Independent predictors of future nonadherence were age at diagnosis (odds ratio [OR]: 0.99 per year), nonadherence (OR: 26.91), a current flare (OR: 1.30) and feelings of anxiety/depression (OR: 1.17), together with an area under the receiver-operating-characteristics curve of 0.74.
CONCLUSIONS
Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.
背景
炎症性肠病（IBD）患者经常出现不遵医嘱的情况。我们旨在确定 IBD 患者未来（不）遵医嘱的预测因素。
方法
我们进行了一项多中心前瞻性队列研究，纳入了成年克罗恩病（CD）和溃疡性结肠炎（UC）患者。通过每 3 个月的疾病进展和医疗保健利用情况问卷收集数据。使用视觉模拟量表评估药物依从性，范围从 0%到 100%。<80%的分数被认为是不依从的。使用简要疾病感知问卷确定疾病感知。我们使用逻辑回归分析确定预测因素评估后 3 个月预测不依从的患者和疾病相关因素。
结果
共纳入 1558 例 CD 患者和 1054 例 UC 患者，并随访了 2.5 年。平均而言，12.1%的 CD 患者和 13.3%的 UC 患者使用 IBD 特异性药物不依从。最常见的不依从发生在使用美沙拉嗪（CD）、布地奈德（UC）和直肠给药治疗（CD 和 UC）的患者中。更高的治疗控制感和对疾病的理解与医疗治疗的依从性相关。未来不依从的独立预测因素是诊断时的年龄（每增加 1 年，OR：0.99）、不依从（OR：26.91）、当前发作（OR：1.30）和焦虑/抑郁感（OR：1.17），ROC 曲线下面积为 0.74。
结论
较低的诊断年龄、发作、焦虑或抑郁感以及不依从与 IBD 患者的未来不依从相关。改变疾病感知可能是改善依从行为的一种方法。
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