口服抗病毒治疗对慢性乙型肝炎的依从性和感知障碍

StephenW

Glob Health Action. 2018;11(1):1433987. doi: 10.1080/16549716.2018.1433987.
Adherence and perceived barriers to oral antiviral therapy for chronic hepatitis B.Xu K1, Liu LM2, Farazi PA1, Wang H3, Rochling FA4, Watanabe-Galloway S1, Zhang JJ2.
Author information
1a Department of Epidemiology, College of Public Health , University of Nebraska Medical Center , Omaha , NE , USA.2b Department of Hepatology , Hubei Third People's Hospital , Wuhan , Hubei , China.3c Department of Health Services Research & Administration, College of Public Health , University of Nebraska Medical Center , Omaha , NE , USA.4d Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine , University of Nebraska Medical Center , Omaha , NE , USA.

AbstractBACKGROUND: Globally, of the 248 million people chronically infected with the hepatitis B virus (HBV), 74 million reside in China. Five oral nucleot(s)ide analogs (NUCs) have been approved for the treatment of chronic hepatitis B (CHB) in China.
OBJECTIVES: The aims of this study were to determine rates of adherence to NUC therapy in patients with CHB, to identify the self-perceived barriers to adherence, and to examine the factors associated with adherence.
METHODS: Questionnaire-based interviews were administered among Chinese patients with CHB at hepatology clinics of a tertiary hospital in the city of Wuhan, China. Adults aged 18 years or older prescribed with NUCs were recruited and interviewed to complete a 27-item questionnaire in a private setting, and adherence was measured using the Morisky Medication Adherence Scale (MMAS-8).
RESULTS: Among 369 participants, only 16.5% had high adherence (score of 8), 32.2% had medium adherence (score of 6 to <8), and 51.2% were measured with low adherence (score of <6). A logistic regression model was used to determine the factors associated with medication adherence. Significant predictors of high adherence consisted of urban residency, non-cirrhotic status, not using prescribed pills other than HBV medications, and reminders from family members. The five most common reasons for skipping NUCs were that medication(s) are expensive (48.7%), forgetfulness (45.1%), have experienced or worry about potential side effects (19.8%), do not want others to know about my medication(s) usage (18.5%), and ran out of pills and do not have time to refill (15.9%).
CONCLUSIONS: This study revealed that adherence rates to oral antiviral therapy were far from optimal. This finding should generate public attention, and it would be beneficial for interventional programs to target Chinese patients from rural regions, as well as patients with low socioeconomic status, cirrhosis, and taking multiple medications.


KEYWORDS: China; Morisky Medication Adherence Scale; chronic hepatitis B; medication adherence; nucleot(s)ide analogs

PMID:29447614DOI:10.1080/16549716.2018.1433987

StephenW

全球卫生行动。 2018; 11（1）：1433987。 doi：10.1080 / 16549716.2018.1433987。
口服抗病毒治疗对慢性乙型肝炎的依从性和感知障碍
许K1，刘LM2，Farazi PA1，王H3，Rochling FA4，Watanabe-Galloway S1，张JJ2。
作者信息

1
    美国内布拉斯加大学医学中心公共卫生学院流行病学系，美国内布拉斯加州奥马哈市。
2
    b湖北省第三人民医院肝病科，湖北武汉。
3
    c美国内布拉斯加大学医学中心公共卫生学院卫生服务研究与管理系，美国内布拉斯加州奥马哈市。
4
    d美国内布拉斯加大学医学中心内科医学系消化内科和肝病科，美国内布拉斯加州奥马哈市。

抽象
背景：

在全球范围内，2.48亿人长期感染乙型肝炎病毒（HBV），其中7400万人居住在中国。五种口服核苷类似物（NUCs）已被批准用于治疗中国的慢性乙型肝炎（CHB）。
目的：

本研究的目的是确定慢性乙型肝炎患者坚持使用NUC疗法的比例，确定自我感知的依从障碍，并检查与依从性相关的因素。
方法：

在中国武汉市的一家三级医院的肝病门诊中，中国CHB患者接受了基于问卷的访谈。在NUC中规定的年满18岁或18岁以上的成年人被招募并采访，在私人环境中完成27项调查问卷，并使用Morisky药物依从性量表（MMAS-8）测量依从性。
结果：

在369名参与者中，只有16.5％的依从性较高（8分），32.2％的中等依从性（6分至8分），51.2％以低依从性评分（得分<6分）。逻辑回归模型被用来确定与药物依从性相关的因素。高度依从性的重要预测因素包括城市居民身份，非肝硬化状态，不使用HBV药物以外的处方药以及家庭成员提醒。跳过NUC的五个最常见的原因是药物昂贵（48.7％），健忘（45.1％），经历或担心潜在副作用（19.8％），不希望别人知道我的药物（ s）使用率（18.5％），耗尽药物，没有时间补充（15.9％）。
结论：

这项研究表明，口服抗病毒治疗的依从率远非最佳。这一发现应该引起公众的关注，而且这对介入治疗项目有利于针对中国农村地区的患者，以及社会经济地位低下，肝硬化患者和服用多种药物的患者。
关键词：

中国; Morisky药物依从性量表;慢性乙型肝炎;服药依从性;核苷酸类似物

结论：
    29447614
DOI：
    10.1080 / 16549716.2018.1433987

StephenW

http://www.tandfonline.com/doi/full/10.1080/16549716.2018.1433987