Analysis Of The Status Of Adherence To Sublingual Immunotherapy And Its Influencing Factors In Patients With Allergic Rhinitis

Objective:To develop a medication adherence scale for patients with allergic rhinitis un dergoing sublingual immunotherapy and use this scale to assess the status of adhe rence to sublingual immunotherapy,analyze its influencing factors;at the same ti me,verify the relationship among beliefs about Medicines,family support,self-effi cacy and medication adherence and analysis of the mediating role of self-efficacy,in order to provide reference for the development of interventions improving adh erence to sublingual immunotherapy for patients with allergic rhinitis.Methods:According to the definition of medication adherence,the formation process,a nd the reference to the existing medication adherence scale,design the entry pool.once again,according to the results of the review and the clinical experience,th e questionnaire is designed.then,the expert panel discussion and pre-survey to co nsummate the first draft of the medication adherence scale and questionnaire.Item distribution survey method,resolution coefficient method and correlation analysis method were used to screen the items of the medication adherence scale.The reli ability and validity of the scale were evaluated by the Cronbach’alpha and the c onfirmatory factor analysis respectively.multiple linear regression analysis was ado pted to explore the influencing factors of adherence to sublingual immunotherapy in patients with allergic rhinitis.SEM is used to verify the relationship among bel iefs about Medicines,family support,self-efficacy,medication adherence and analy ze the mediating role of self-efficacy in it.Statistical software SPSS 24 and Amo s 21.0 was used to data analysis.Results:1.According to the records of outpatients of the Allergy Department of Otol aryngology Head and Neck Surgery from XX from December 2014 to May 2017,210 patients were selected according to the inclusion criteria.210 electronic ques tionnaires were issued through a retrospective telephone follow-up and WeChat.167 questionnaires were returned.From May 2017 to December 2017,patients who had completed the electronic questionnaire were excluded and 40 questionnaires w ere distributed on-site and 38 were recovered.A total of 205 valid questionnaires were eventually recovered.2.Development of medication adherence scale for people with allergic rhinitis undergoing sublingual immunotherapy.The Medication adherence Scale contains t wo dimensions:the reason for non-compliance,the complexity of the program,an d a total of 7 items.The Cronbachαcoefficient of the scale was 0.815,and the reliability was good.The confirmatory factor analysis showed that the standardize d factor load of each item was between 0.59-0.89,and the two-dimension CR an d AVE values were 0.832,0.72 and 0.5,0.579,respectively,the fitness index:χ~2/df=0.4991,RMSEA=0.140,GFI=0.916,CFI=0.896,NFI=0.876,PCFI=0.555,PNFI=0.542.3.Analysis of the status of adherence to sublingual immunotherapy and its in fluencing factors in patients with allergic rhinitis.(1)The results showed that during the 2 weeks before the survey only 20%o f patients had higher medication adherence than the medium level,1.95%of patie nts never forgot to take Changdi;24.39%of patients forget to took Changdi more than 3 times;.7.8%of patients took the medicine at the prescribed time;30.73%of the patients didn’t take the medicine at the prescribed time more than 3 times;2.44%of patients didn’t suspend medication due to adverse drug reactions or agg ravation of symptoms.21.95%of patients suspended medication for more than 3 t imes because of adverse drug reactions or aggravation of symptoms;3.9%of pati ents didn’t suspend medication because of improvement of symptoms,21.95%of patients suspended medication for more than 3 times because symptoms improved;1.95%of patients didn’t adjust their doses without the consent of their doctors,12.2%of patients adjusted their doses more than 3 times without the doctor’s cons ent.In total,the majority of patients had 1-3 times of missed medications,missed schedules,and not taking medications by dosage during the 2 weeks prior to the survey.(2)Multiple linear regression analysis showed that self-efficacy,family support,the medication time(in the case of control of other independent variables,the a dherence of patients with medication for more than 2 years was better than the a dherence of patients with medication of 3-6 months,the score difference was 2.527 points,P=0.004),can bear the cost of medication,consciously desensitization treatment effect,medication belief,medication knowledge and whether the residenc e affected the medical treatment are the factors affecting medication adherence,ad just R~2=0.634,indicating that the above independent variables can explain the 63.4%variation in medication adherence.4.Study on the mechanism of adherence to sublingual immunotherapy for A R patients.The SEM further quantified the relationship between the four constru cts and demonstrated:medication beliefs→self-efficacy(β=0.352),family support→self-efficacy(β=0.471),self-efficacy→medication adherence(β=0.482),family sup port→medication adherence(β=0.482),medication beliefs→self efficacy→medicatio n adherence(β=0.352*0.482=0.170),family support→self efficacy→medication com pliance(β=0.482*0.471=0.227),and above the path coefficients are statistically si gnificant.The results of the mediator test show that self-efficacy is the mediator variable of family support and medication belief affecting medication adherence.T he total effect of family support on medication adherence was 0.716(0.227+0.488.Conclusion:1.The medication adherence scale developed by this research has high reliability,t he confirmatory factor analysis showed that the theoretical factor structure of the scale was well-fitted with the sample data collected and it can be used as an effective tool to measure medication adhenrence of sublingual desensitization for patients with allergic rhinitis.It is necessary to further evaluate and verify the reliability,validity and practicability of scales in patients with allergic rhinitis in other regions and at all ages.2.Only 20%of patients had higher medication adherence than the medium level.In total,the majority of patients had 1-3 times of missed medications,missed schedules,and not taking medications by dosage during the 2 weeks prior to the survey.The status of medication adherence is not optimistic,Self-efficacy and family support have a greater impact on medication adherence,suggesting that health care workers should do a good job of health education and follow-up plans,encourage patients to create a good family atmosphere and R&D personnels of pharmaceutical companies should strive to develop high-quality desensitizing agents,simplify treatment programs,shorten treatment duration,and reduce adverse reactions.3.Through the construction of SEM,the relationship between family support,medication beliefs,self-efficacy,and medication adherence was basically verified.Family support and medication beliefs influence of medication compliance behaviors by self-efficacy.Family support can directly influence medication compliance behaviors.However,the influence of family support on medication adherence is greater than the effect of medication beliefs on medication adherence.This result suggests that It is necessary to improve the family support function and reduce the patient’s medication concerns to improve the patient’s adherence medication.