Abstract：
OBJECTIVE: Improving understanding of actual pulmonary hypertension (PH) treatment adherence patterns is crucial to properly treating these patients. We aimed to primarily assess adherence to treatments used for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) specific therapies, identify potential factors related to it and secondly describe its treatment patterns.
METHODS: A 6-month observational cross-sectional study in a tertiary care hospital was conducted. Patients with PH-targeted therapy who picked it up in the ambulatory hospital pharmacy and who had been on treatment with the same drug for at least 1 year were included. Adherence was assessed as: 1) Proportion of days covered (PDC); and 2) Simplified Medication Adherence Questionnaire (SMAQ). PDC ≥80% was considered adherent. Statistical analyses were performed to evaluate the study outcomes. Logistic regressions were estimated to identify the association between baseline characteristics and factors associated with adherence. P < 0.05 indicated statistical significance.
RESULTS: A total of 63 patients with 127 different treatments were included, 71.4% were females with a mean age (SD) of 59 (15) years. PAH was the most common diagnosis (74.6%). Double therapy was used in 39.7% of patients, being the combination of Macitentan + Tadalafil and Ambrisentan + Tadalafil the most prescribed. Endothelin receptor antagonists were the most used treatment (40.2%). Adherence according to PDC was 93.7%, showing no great differences depending on the targeted drug used, and according to SMAQ 61.9%. The agreement degree of both methods was slight (65.1%; Kappa 0.12). Only female sex (OR: 0.23, 95% CI: 0.06-0.90; p = 0.035) was associated with worse adherence in the SMAQ method but not in the PDC. Adverse events were reported by a 55.6% of participants and the perception of effective treatment was high (95.2%).
CONCLUSIONS: Adherence to PH therapy differs depending on the assessment method; PDC showed greater adherence rate than SMAQ. According to SMAQ, female sex may have a negative impact on adherence in this cohort, but PDC revealed no factors influencing it. No notable differences in adherence between treatment types were found and generally patients felt the treatments were effective in controlling their disease.
METHODS: A 6-month observational cross-sectional study in a tertiary care hospital was conducted. Patients with PH-targeted therapy who picked it up in the ambulatory hospital pharmacy and who had been on treatment with the same drug for at least 1 year were included. Adherence was assessed as: 1) Proportion of days covered (PDC); and 2) Simplified Medication Adherence Questionnaire (SMAQ). PDC ≥80% was considered adherent. Statistical analyses were performed to evaluate the study outcomes. Logistic regressions were estimated to identify the association between baseline characteristics and factors associated with adherence. P < 0.05 indicated statistical significance.
RESULTS: A total of 63 patients with 127 different treatments were included, 71.4% were females with a mean age (SD) of 59 (15) years. PAH was the most common diagnosis (74.6%). Double therapy was used in 39.7% of patients, being the combination of Macitentan + Tadalafil and Ambrisentan + Tadalafil the most prescribed. Endothelin receptor antagonists were the most used treatment (40.2%). Adherence according to PDC was 93.7%, showing no great differences depending on the targeted drug used, and according to SMAQ 61.9%. The agreement degree of both methods was slight (65.1%; Kappa 0.12). Only female sex (OR: 0.23, 95% CI: 0.06-0.90; p = 0.035) was associated with worse adherence in the SMAQ method but not in the PDC. Adverse events were reported by a 55.6% of participants and the perception of effective treatment was high (95.2%).
CONCLUSIONS: Adherence to PH therapy differs depending on the assessment method; PDC showed greater adherence rate than SMAQ. According to SMAQ, female sex may have a negative impact on adherence in this cohort, but PDC revealed no factors influencing it. No notable differences in adherence between treatment types were found and generally patients felt the treatments were effective in controlling their disease.
摘要：
目的：提高对实际肺动脉高压（PH）治疗依从性模式的了解对于正确治疗这些患者至关重要。我们旨在主要评估对肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）特异性疗法的治疗依从性。找出与之相关的潜在因素，其次描述其治疗模式。
方法：在一家三级医院进行了为期6个月的观察性横断面研究。包括在门诊医院药房接受PH靶向治疗并且使用相同药物治疗至少1年的患者。依从性被评估为:1)覆盖天数的比例(PDC);和2)简化的药物依从性问卷(SMAQ)。PDC≥80%被认为是粘附性的。进行统计分析以评估研究结果。估计Logistic回归以确定基线特征和与依从性相关的因素之间的关联。P<0.05表示有统计学意义。
结果：共纳入63例患者，采用127种不同的治疗方法，71.4％为女性，平均年龄（SD）为59（15）岁。PAH是最常见的诊断（74.6%）。39.7%的患者采用双重疗法,作为Macitentan+他达拉非和Ambrisentan+他达拉非的组合，处方最多。内皮素受体拮抗剂是最常用的治疗方法(40.2%)。根据PDC，坚持率为93.7%，根据所使用的靶向药物没有很大的差异，根据SMAQ的61.9%。两种方法的一致性程度均较小（65.1％；Kappa0.12）。只有女性性别（OR：0.23，95％CI：0.06-0.90；p=0.035）与SMAQ方法的依从性较差相关，而与PDC无关。55.6％的参与者报告了不良事件，对有效治疗的看法很高（95.2％）。
结论：对PH治疗的依从性因评估方法而异；PDC的依从性高于SMAQ。根据SMAQ,在这个队列中，女性性别可能会对依从性产生负面影响，但是PDC没有发现影响它的因素。在治疗类型之间的依从性没有发现显着差异，并且通常患者认为这些治疗方法有效地控制了他们的疾病。
方法：在一家三级医院进行了为期6个月的观察性横断面研究。包括在门诊医院药房接受PH靶向治疗并且使用相同药物治疗至少1年的患者。依从性被评估为:1)覆盖天数的比例(PDC);和2)简化的药物依从性问卷(SMAQ)。PDC≥80%被认为是粘附性的。进行统计分析以评估研究结果。估计Logistic回归以确定基线特征和与依从性相关的因素之间的关联。P<0.05表示有统计学意义。
结果：共纳入63例患者，采用127种不同的治疗方法，71.4％为女性，平均年龄（SD）为59（15）岁。PAH是最常见的诊断（74.6%）。39.7%的患者采用双重疗法,作为Macitentan+他达拉非和Ambrisentan+他达拉非的组合，处方最多。内皮素受体拮抗剂是最常用的治疗方法(40.2%)。根据PDC，坚持率为93.7%，根据所使用的靶向药物没有很大的差异，根据SMAQ的61.9%。两种方法的一致性程度均较小（65.1％；Kappa0.12）。只有女性性别（OR：0.23，95％CI：0.06-0.90；p=0.035）与SMAQ方法的依从性较差相关，而与PDC无关。55.6％的参与者报告了不良事件，对有效治疗的看法很高（95.2％）。
结论：对PH治疗的依从性因评估方法而异；PDC的依从性高于SMAQ。根据SMAQ,在这个队列中，女性性别可能会对依从性产生负面影响，但是PDC没有发现影响它的因素。在治疗类型之间的依从性没有发现显着差异，并且通常患者认为这些治疗方法有效地控制了他们的疾病。
