지역사회 뇌졸중 환자들의 이차 예방을 위한 치료 지속률과 약물 순응도 관련 요인
Predictors of Persistence and Adherence with Secondary Preventive Medication in Stroke Patients
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Objectives: This study aimed to explore the persistence and adherence to secondary preventive medicationof stroke patients after discharge and to assess the reasons for persistence and nonadherence. Methods: Four hundred twenty-nine patients with stroke were surveyed to determine their behaviors fromdischarge. Reasons for stopping medications were ascertained. Persistence was defined as continuation of allsecondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribedmedications according to health care provider instructions. Results: Of the 429 patients, 86.5% were treatment persistent and 41.2%(non-intentional nonadherence=39.4%,intentional nonadherence=19.4%) were adherent. Independent predictors of persistence included havingexperience about health education. Independent predictors of non-intentional nonadherence were modifiedRankin Scale(mRS) (Exp(B)=2.858, p=0.001) and health education experience (Exp(B)=0.472, p=0.032), andindependent predictors of intentional nonadherence were mRS (Exp(B)=2.533, p=0.006), depressive symptoms(Exp(B)=1.113, p=0.016), beliefs about medications questionnaire(necessity, Exp(B)=0.879, p=0.011, concern,Exp(B)=1.098, p=0.019). Conclusions: Although up to one-ninth of stroke patients continued secondary prevention medications,nonadherence is common. Several potentially modifiable patient, provider, and system-level factors associatedwith persistence and adherence may be targets for future interventions. Specially, interventions to improveadherence should target patients’ beliefs about their medication.
Abstract
Objectives: This study aimed to explore the persistence and adherence to secondary preventive medicationof stroke patients after discharge and to assess the reasons for persistence and nonadherence. Methods: Four hundred twenty-nine patients with stroke were surveyed to determine their behaviors fromdischarge. Reasons for stopping medications were ascertained. Persistence was defined as continuation of allsecondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribedmedications according to health care provider instructions. Results: Of the 429 patients, 86.5% were treatment persistent and 41.2%(non-intentional nonadherence=39.4%,intentional nonadherence=19.4%) were adherent. Independent predictors of persistence included havingexperience about health education. Independent predictors of non-intentional nonadherence were modifiedRankin Scale(mRS) (Exp(B)=2.858, p=0.001) and health education experience (Exp(B)=0.472, p=0.032), andindependent predictors of intentional nonadherence were mRS (Exp(B)=2.533, p=0.006), depressive symptoms(Exp(B)=1.113, p=0.016), beliefs about medications questionnaire(necessity, Exp(B)=0.879, p=0.011, concern,Exp(B)=1.098, p=0.019). Conclusions: Although up to one-ninth of stroke patients continued secondary prevention medications,nonadherence is common. Several potentially modifiable patient, provider, and system-level factors associatedwith persistence and adherence may be targets for future interventions. Specially, interventions to improveadherence should target patients’ beliefs about their medication.
참고문헌 (31)
- "Annual Report on The Causes of Death Statistics"[URL]
- Mohan KM, "Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis", Stroke, 42(5), pp.1489~1494 (2011)
- Antiplatelet Trialist’s Collaboration, "Secondary prevention of vascular disease by prolonged antiplatelet treatment", BMJ, 296(6618), pp.320~331 (1988)
- Antiplatelet Trialist’s Collaboration, "Collaborative overview of randomized trials of antiplatelet therapy-I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients", BMJ, 308(6921), pp.81~106 (1994)
- Ovbiagele B, "In-hospital initiation of secondary stroke prevention therapies yields high rates of adherence at follow-up", Stroke, 35(12), pp.2879~2883 (2004)
- Rahiman A, "In-hospital initiation of secondary prevention is associated with improved vascular outcomes at 3 months", J Stroke Cerebrovasc Dis, 17(1), pp.5~8 (2008)
- Bushnell C, "The Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) registry: design, rationale, and baseline patient characteristics", Am Heart J, 157(3), pp.428~435 (2009)
- Bushnell CD, "Secondary preventive medication persistence and adherence 1 year after stroke", Neurology, 77(12), pp.1182~1905 (2011)
- Lehane E, "Intentional and unintentional medication non-adherence: A comprehensive framework for clinical research and practice? A discussion paper", Int J Nurs Stud, 44(8), pp.1468~1477 (2007)
- Hugtenburg JG, "Definitions, variants, and causes of nonadherence with medication:A challenge for tailored interventions", Patient Prefer Adherence, 7, pp.675~ (2013)
- Wroe AL, "Intentional and unintentional nonadherence: A study of decision making", J Behav Med, 25(4), pp.355~372 (2002)
- Lowry KP, "Intentional and unintentional nonadherence to antihypertensive medication", Ann Pharmacother, 39(7-8), pp.1198~1203 (2005)
- Lehane E, "An examination of the intentional and unintentional aspects of medication non‐adherence in patients diagnosed with hypertension", J Clin Nurs, 16(4), pp.698~706 (2007)
- Horne R, "Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions:a meta-analytic review of the Necessity-Concerns Framework", PLoS One, 8(12), pp.e80633~ (2013)
- Horne R, "Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness", J Psychosom Res, 47(6), pp.555~567 (1999)
- Jung JH, "Medication Adherence in Patients Taking Immunosuppressants after Kidney Transplantation", J Korean Soc Transplant, 24(4), pp.289~297 (2010)
- 이종경, "다약제 복용 노인의 약물 오용 행위에 영향을 미치는 요인", 성인간호학회지, 23(6), pp.554~563 (2011), 성인간호학회
- 홍근식, "뇌졸중 임상시험에서 결과변수의 평가 및 분석", 대한뇌졸중학회지, 13(1), pp.1~10 (2011), 대한뇌졸중학회
- 강현철, "구성타당도 평가에 있어서 요인분석의 활용", Journal of Korean Academy of Nursing, 43(5), pp.587~594 (2013), 한국간호과학회
- Lubben J, "Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations", Gerontologist, 46(4), pp.503~513 (2006)
- Hong M, "Validation of Korean versions of the Lubben social network scales in Korean Americans", Clinical gerontologist, 34(4), pp.319~334 (2011)
- Ki BS, "A preliminary study for the standardization of geriatric depression scale short form-Korea version", J Korean Neuropsychatr Assoc, 35(2), pp.298~307 (1996)
- Osterberg L, "Adherence to medication", N Engl J Med, 353(5), pp.487~497 (2005)
- Koh IS, "The compliance of stroke patients for secondary prevention", Seoul & Kyunggi Province J Kor Neurol Ass, 17(4), pp.472~477 (1999)
- Lummis HL, "Medication persistence rates and factors associated with persistence in patients following stroke: a cohort study", BMC Neurol, 8, pp.25~ (2008)
- Jang SH, "Change in health behaviors of patients before and after stroke", Korean J of Rural Med, 27(1), pp.9~19 (2002)
- 김성옥, "고혈압과 당뇨병 노인의 복약순응도와 이에 영향을 미치는 요인", 한국임상약학회지, 21(2), pp.81~89 (2011), 한국임상약학회
- Kirkpatrick AC, "Cognitive impairment is associated with medication nonadherence in asymptomatic carotid stenosis", Am J Med, 127(12), pp.1243~1246 (2014)
- Ji R, "Persistence of secondary prevention medications after acute ischemic stroke or transient ischemic attack in Chinese population: data from China National Stroke Registry", Neurol Res, 35(1), pp.29~36 (2013)
- DiMatteo MR, "Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence", Arch Intern Med, 160(14), pp.2101~2107 (2000)
- Leventhal H, "Health psychology: The search for pathways between behavior and health", Annu Rev Psychol, 59, pp.477~505 (2008)