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Compliance with antiviral therapy in patients with chronic hepatitis B
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摘要: 目的研究慢性乙型肝炎患者的服药依从性并分析其影响因素。方法采用回顾性队列研究,选取2011年1月1日-2016年12月31日广州市第八人民医院门诊治疗的3732例慢性乙型肝炎患者,通过医院信息系统收集其人口学特征、就诊医生资料、取药信息、检查信息,依据药物持有率将患者分为良好依从性组（n=2346）与不良依从性组（n=1386）,采用χ2检验比较两组间的人口学特征和诊疗情况,影响因素分析采用两水平稳健Poisson方差成分模型。结果慢性乙型肝炎患者药物持有率为0. 789±0. 269,持有率在0. 8以上的良好依从性患者占比62. 86%。多因素分析结果显示,结算方式、治疗时间、医生职称及用药模式是良好依从性的影响因素（P值均<0. 05）。在控制了其他协变量后,医保患者其良好依从性比自费患者高0. 119倍;良好依从性总体呈下降趋势,第2～5年的良好依从性分别是第1年的84. 7%、77. 3%、78. 5%、65. 9%;副主任医师负责的患者,其良好依从性比主治及住院医师负责的患者高0. 249倍;服用替比夫定的患者其良好依从性比服用恩替卡韦的患者高0...Abstract: Objective To investigate the medication compliance in patients with chronic hepatitis B and related influencing factors. Methods A retrospective cohort study was conducted for 3732 patients with chronic hepatitis B who were treated in the outpatient service of Guangzhou Eighth People's Hospital from January 1,2011 to December 31,2016,and related clinical data were collected from the hospital's information system,including demographic features,information of the physician in charge,medication information,and examination data. According to the medication possession ratio( MPR),the patients were divided into good compliance group with 2346 patients and poor compliance group with 1386 patients. The chi-square test was used to compare demographic features,diagnosis,and treatment between the two groups,and the two-level robust Poisson regression model was used to analyze influencing factors. Results The patients with chronic hepatitis B had an MPR of 0. 789 ± 0. 269,and 62. 86% of the patients with good compliance had an MPR of > 0. 8. The multivariate analysis showed that method of payment,time of treatment,physician's professional title,and pattern of medication were the influencing factors for compliance( all P < 0. 05). After the control of the other covariants,the proportion of patients with good compliance among the patients covered by medical insurance was 0. 119 times higher than that among the self-paying patients. The proportion of patients with good compliance tended to decrease in general,and the proportion of patients with good compliance in the 2th-5th years was15. 3%,22. 7%,21. 5%,and 34. 1%,respectively,lower than that in the first year. The proportion of patients with good compliance among the patients under the charge of an associate chief physician was 0. 249 times higher than that among the patients under the charge of an attending physician or a resident. The proportion of patients with good compliance among the patients receiving telbivudine was 0. 120 times higher than that among the patients taking entecavir. Conclusion Medication compliance of patients with chronic hepatitis B is closely associated with medical insurance,time of treatment,professional title of the physician in charge,and pattern of medication. The patients without medical insurance should be encouraged to purchase medical insurance. It is important to strengthen health education among patients with chronic hepatitis B and promote them to follow the guidelines for the treatment of chronic hepatitis B.
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Key words:
- hepatitis B,chronic /
- medication adherence /
- influencing factor
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