■不坚持是常见的,会导致不良的健康结果,生活质量下降,增加医疗支出。本研究的目的是使用两种在临床实践中有用且容易的自我报告方法(SRM)评估诊断有效性,以估计轻度认知障碍(MCI)和痴呆症患者的不依从性患病率。考虑药丸计数作为参考方法(RM)。
■队列研究嵌套在一项多中心随机对照试验NCT03325699中。使用非概率连续抽样方法从8个健康中心总共选择了387名患者。纳入标准如下:迷你精神状态检查(MMSE)得分为20-28分;年龄超过55岁;服用处方药;并负责自己的药物使用。参与者在基线访视后随访18个月,即,6、12和18个月。在所有访问中测量与治疗依从性相关的变量。变量包括年龄,性别,治疗,合并症,和MMSE测试。坚持包括药丸计数和Morisky-Green检验(MGT)和Batalla检验(BT)作为SRM。统计分析包括描述性分析和95%置信区间(CI)。诊断有效性包括以下内容:1)SRM和RM之间的开放比较统计关联,以及2)层次结构比较:RM作为评估不依从性的最佳方法,Kappa值(k),灵敏度(S),特异性(Sp),和似然比(PPV/PPN)。
■共招募了387名患者,平均年龄为73.29岁(95%CI,72.54-74.04),其中59.5%为女性。合并症为54.4%HTA,35.9%骨关节病理,和24.5%DM。MMSE平均得分为25.57(95%CI,25.34-25.8)。RM的治疗依从性在基线的22.5%和26.3%之间波动,14.8%,在后续访问中占17.9%。对于SRM,治疗依从性在基线的43.5%和32.4%之间波动,21.9%,在后续访问中占20.3%。在所有访视的所有比较中,kappa值具有统计学显著性,得分在0.16和035之间。关于诊断的有效性,对于MGT来说,灵敏度在0.4和0.58之间振荡,特异性在0.68和0.87之间振荡;对于BT,灵敏度在0.4和0.7之间振荡,特异性在0.66和0.9之间振荡;当两种测试一起使用时,灵敏度在0.22和0.4之间振荡,特异性在0.85和0.96之间振荡。
■SRM正确分类非粘附受试者。它们非常容易使用,并在临床实践中产生快速结果,因此SRM将用于MCI和轻度痴呆患者的非依从性诊断。
UNASSIGNED: Non-adherence is common and contributes to adverse health outcomes, reduced quality of life, and increased healthcare expenditure. The objective of this study was to assess the diagnostic validity to estimate the prevalence of non-adherence in patients with mild cognitive impairment (MCI) and dementia using two self-reported methods (SRMs) that are useful and easy in clinical practice, considering the pill count as a reference method (RM).
UNASSIGNED: The cohort study was nested in a multicenter randomized controlled trial NCT03325699. A total of 387 patients from 8 health centers were selected using a non-probabilistic consecutive sampling method. Inclusion criteria were as follows: a score of 20-28 points on the Mini-Mental State Examination (MMSE); older than 55 years; taking prescribed medication; and are in charge of their own medication use. Participants were followed up for 18 months after the baseline visit, i.e., 6, 12, and 18 months. Variables related with treatment adherences were measured in all visits. The variables included age, sex, treatment, comorbidities, and the MMSE test. Adherences included pill counts and Morisky-Green test (MGT) and Batalla test (BT) as SRMs. Statistical analysis included descriptive analysis and 95% confidence intervals (CIs). The diagnostic validity included the following: 1) open comparison statistical association between SRMs and RMs and 2) hierarchy comparison: the RM as the best method to assess non-adherence, kappa value (k), sensitivity (S), specificity (Sp), and likelihood ratio (PPV/PPN).
UNASSIGNED: A total of 387 patients were recruited with an average age of 73.29 years (95% CI, 72.54-74.04), of which 59.5% were female. Comorbidities were 54.4% HTA, 35.9% osteoarticular pathology, and 24.5% DM. The MMSE mean score was 25.57 (95% CI, 25.34-25.8). The treatment adherence for the RM oscillates between 22.5% in the baseline and 26.3%, 14.8%, and 17.9% in the follow-up visits. For SRMs, the treatment adherence oscillates between 43.5% in the baseline and 32.4%, 21.9%, and 20.3% in the follow-up visits. The kappa value was statistically significant in all the comparison in all visits with a score between 0.16 and 035. Regarding the diagnostic validity, for the MGT, the sensibility oscillated between 0.4 and 0.58, and the specificity oscillated between 0.68 and 0.87; for the BT, the sensibility oscillated between 0.4 and 0.7, and the specificity oscillated between 0.66 and 0.9; and when both tests were used together, the sensibility oscillated between 0.22 and 0.4, and the specificity oscillated between 0.85 and 0.96.
UNASSIGNED: SRMs classify non-adherent subjects correctly. They are very easy to use and yield quick results in clinical practice, so SRMs would be used for the non-adherence diagnosis in patients with MCI and mild dementia.