Morisky问卷评价精神分裂症恢复期患者服药依从性的信度和效度

目的:评价Morisky问卷对精神分裂症患者服药依从性的信度和效度。方法:采用便利取样法选取125例精神分裂症恢复期患者进行Morisky问卷调查,7 d后对其中30例患者进行Morisky问卷重测,计算Cronbach'sα系数及重测信度,评价量表的信度;采用探索性因子分析方法考评量表结构效度。结果:采用条目-总分相关法及决断值法对条目的区分度进行分析,问卷的4个条目皆达显著水平,符合选题标准,可以保留。问卷总Cronbach'sα系数为0.78,7 d后重测信度为0.84。经最大方差旋转法旋转后提取1个因子,累计解释的方差为52.25%,4个条目的因子负荷0.65~0.78之间。结论:Morisky问卷在精神分裂症恢复期患者服药依从性中有较好的信度及效度。     

Assessment of medication adherence and treatment satisfaction in Japanese patients with psoriasis of various severities

Psoriasis is a chronic, relapsing, inflammatory keratotic skin disease. To elucidate the medication adherence and treatment satisfaction, we performed a questionnaire survey using the eight‐item Morisky Medication Adherence Scale (MMAS‐8) and nine‐item Treatment Satisfaction Questionnaire for Medication (TSQM‐9) of 163 psoriatic patients who regularly visited hospitals or clinics. To assess the relationship between the MMAS‐8/TSQM‐9 outcomes and severity of psoriasis, two different clinical severity indices were used: the Psoriasis Area and the Severity Index (PASI) for disease severity and the Psoriasis Disability Index (PDI) for quality of life (QOL) impairment. The MMAS‐8 score for oral medication was significantly higher than that for topical medication. The oral and topical MMAS‐8 scores were significantly correlated with the PDI score, but not with the PASI score, indicating that QOL impairment lowered treatment motivation. All of the TSQM‐9 domain scores (effectiveness, convenience and global satisfaction) were significantly correlated with both the PASI and PDI scores, suggesting that patients whose skin and QOL conditions were under good control had high satisfaction with treatment. Patients treated with biologics had higher satisfaction than those treated with non‐biologics.     

Évaluation de l’adhérence aux médicaments antihypertenseurs chez des patients avec hypertension artérielle résistante recevant un traitement optimal

ObjectivesThe primary objective was to estimate the proportion of non-adherence to antihypertensive drugs in patients with an apparently resistant hypertension despite optimal medical treatment. The secondary objective was to identify related factors to poor adherence.MethodsMonocentric, prospective and observational study, including consecutive patients, managed for an apparently resistant hypertension between January 2014 and December 2017, with an ambulatory blood pressure measurement (ABP) in the past year and a thorough etiological work up in the 2 past years. Hypertension was considered resistant if the daytime ABP was ≥ 135/85 mmHg and/or the 24 hours ABP ≥ to 130/80 mmHg, despite 4 antihypertensive medications at optimal doses. Adherence to treatment was assessed by the eight-item Morisky Scale (MMAS-8).ResultsWe enrolled 386 patients, with a mean age of 64.6 years, and 48.2% of men. The mean office blood pressure, 24 hours and daytime APB were 178.6/101.3 mmHg, 164.4/97.2 mmHg and 170.5/99.7 mmHg respectively. The proportions of low, medium and high adherence were 24.5%, 47.6% and 27.9% respectively. Associated-factors with poor adherence were female sex, low education level, celibacy, polypharmacy and lack of home self-blood pressure monitoring.ConclusionOver two out of three patients with an apparently resistant hypertension under optimal treatment were partially or fully nonadherent to treatment in our study. Assessment of adherence would be systematic in these patients before implementing complex investigations or non-pharmacologic invasive procedures.     

Predictors of refill non-adherence in patients with heart failure

AIM: To identify the health beliefs and patient characteristics associated with medication non-adherence in patients attending a heart failure outpatient clinic. METHODS: A survey was administered to 350 consenting clinic patients. Questions focused on relevant demographic and clinical characteristics, the Health Belief Model, the Beliefs About Medicines Questionnaire and the Multidimensional Health Locus of Control. Multivariate logistic regression was used to identify independent predictors of refill non-adherence (<90%). RESULTS: Refill non-adherence was found in 77 (22%) participants. Being a smoker [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.0, 5.8, P = 0.045], two or fewer medication administration times (OR 2.4, 95% CI 1.2, 4.6, P = 0.01), and positive response to 'Have you changed your daily routine to accommodate your heart failure medication schedule' (OR 2.4, 95% CI 1.2, 4.5, P = 0.01) were the independent predictors of refill non-adherence. CONCLUSION: Perceptions regarding barriers to medication taking and fewer administration times could result in medication non-adherence in congestive heart failure patients. Medication regimens should be designed after accounting for patients' existing routines.     

Effect of a community-based intervention on self-care among diabetes patients in rural Tamil Nadu: A mixed-method study

IntroductionPeer support models for the management of diabetes self-care have been hailed as a promising solution to strengthen a formal health system to support diabetes patients. Diabetes self-care in patients can truncate the risk factors and reduce the complications.ObjectiveTo identify self-care level (adherence to the diet, exercise, treatment) and depression among known diabetes patients and to find the effect of the support group intervention on diabetes self-care.Methods and materialA Sequential type Embedded Mixed-Method study (qual→QUAN(qual)→qual) was conducted in three phases in 168 known diabetes adults aged ≥ 30 years in a rural setting. After obtaining IEC clearance, the intervention was carried out over eight months, forming peer support groups in four villages. Each group comprises between six to 12 participants. Assessment of self-care, treatment adherence and depression with standardized scales.Data analysisA manual content analysis was performed on the qualitative data. The Wilcoxon rank test was used to compare the quantitative data before and after intervention and analyzed using SPSS (Version_24) software package.ResultsIn this study, we found improved self-care practices and treatment adherence among study participants (p < 0.001). About 88.7% of participants said that the support group was useful and provided moral support for diabetes.ConclusionWe found an improvement in treatment adherence, self-care among diabetes patients’ and marginal improvement in depression status through support group intervention. Also the peer support group was well accepted, and it provided the low-cost, feasible intervention respect to the chronic conditions like diabetes, by addressing their behavioral changes and support from community. By sustaining the support group, might able to achieve the efficient health care in high quality even at resource-poor settings.Key messagesA Community-Based intervention for the diabetes self-care using peer support group among the diabetes patients will improve the self-care practices in the area with limited access to healthcare and financial resources, it provides a low-cost, flexible, culturally sensitive approach to support self-care management and reduce the further complications among It also imporve the problem-solving capacity and social support from families and peers patients.     

The 8-item Morisky Medication Adherence Scale: Validation of a Brazilian–Portuguese version in hypertensive adults

BackgroundThe Morisky Medication Adherence Scale (MMAS-8) remains one of the most widely used mechanisms to assess patient adherence. Its translation and testing on languages in addition to English would be very useful in research and in practice.ObjectiveTo translate and examine the psychometric properties of the Portuguese version of the structured self-report eight-item Morisky Medication Adherence Scale among patients with hypertension.MethodsThe study was designed as a cross-sectional survey conducted in six Family Health Units of the Brazilian Unified Health System, in Maceió, between March 2011 and April 2012. After a standard “forward–backward” procedure to translate MMAS-8 into Portuguese, the questionnaire was applied to 937 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach's alpha), and test–retest reliability. Validity was confirmed using known groups validity. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); 8 (high).ResultsThe mean age of respondents was 57.1 years (SD = 12.7 years), and 71.5% were female. The mean number of prescribed antihypertensives per patient was 1.62 (SD = 0.67). The mean score for the medication adherence scale was 5.78 (SD = 1.88). Moderate internal consistency was found (Cronbach's alpha = 0.682), and test–retest reliability was satisfactory (Spearman's r = 0.928; P < 0.001). A significant relationship between MMAS-8 levels of adherence and BP control (chi-square, 8.281; P = 0.016) was found. 46.0%, 33.6%, and 20.4% of patients had low, medium, and high adherence, respectively. The self-report measure sensitivity, specificity, positive and negative predictive values were 86.1%, 31.2%, 57.4% and 68.3% respectively.ConclusionsPsychometric evaluation of the Portuguese version of the MMAS-8 indicates that it is a reliable and valid measure to detect patients at risk of non-adherence. The MMAS-8 could still be used in routine care to support communication about the medication-taking behavior in hypertensive patients.     

Factors influencing illness representations and perceived adherence in haemophilic patients: a pilot study

Illness representations of chronic patients are important to explain adherence and preventive behaviours. However, it is unclear if the patient's objective health status may influence illness representations and perceived adherence. This study explored if health status and socio‐demographic characteristics influence illness representations and perceived adherence in haemophilic patients. Fifty patients (25 on‐demand and 25 on prophylaxis) ageing from 13–73, completed the Illness Perceptions Questionnaire‐Revised and the Morisky Medication Adherence Scale. Patients' cognitive illness representations were influenced by type of treatment, haemophilia severity, presence of inhibitor and co‐morbidity. Perceived chronicity was influenced by patient's age (P = 0.021). Perceived adherence was not influenced by the health status, but was affected by the relationship status (P = 0.048). Perceived adherence was predicted by perceived chronicity (β = 0.412; P = 0.003) and by emotions (β = ?0.308; P = 0.023). Patient's health status seems to affect cognitive illness representations but not perceived adherence. Perceived chronicity and negative emotions, which affected perceived adherence, were not influenced by the health status. Physician–patient communication addressing perceived chronicity and emotions rather than patients' health status may influence patient's adherence. Psycho‐educational groups could be offered to promote patient's well‐being and adjustment to haemophilia, and improve adherence.