Development Of Adherence Assessment Tool And Analysis Of Influencing Factors In Patients With Chronic Airway Disease

Objective: to develop a tool to evaluate the adherence of patients with chronic airway disease with inhaled drug treatment,and to test its reliability and validity;to use a self-developed tool to evaluate the status quo of adherence of patients with chronic airway disease with inhaled drug treatment;to analyze the influencing factors of adherence of inhaled drug treatment,and to provide theoretical basis for clinical interventions.Methods: on the basis of confirming the operational definition of the adherence of the patients with chronic airway disease,and through the systematic literature review and analysis,combined with the existing domestic and foreign questionnaire related to the adherence of the patients with chronic airway disease to form the item pool of the questionnaire.The initial questionnaire was formed through expert consultation.The content validity index was used to test the validity of the questionnaire,and the internal consistency reliability and retest reliability were used to test the reliability of the questionnaire.183 patients with chronic airway disease were selected from the outpatient department of respiratory department of the First Affiliated Hospital of China Medical University by continuous sampling.The patients' general information,treatment adherence and disease knowledge were assessed by general data questionnaire,inhalation medication adherence questionnaire,asthma knowledge questionnaire,COPD-Q questionnaire,and the severity of the disease was assessed by act score and cat score.The adherence of patients with chronic airway disease was analyzed by one-way ANOVA and t-test,and multivariate linear regression was used in multivariate analysis.Result:1.Basic information of research object A total of 183 questionnaires were sent out and 180 effective questionnaires were returned.The effective recovery rate was 98.36%.There were 106 cases of asthma and 74 cases of COPD.The average age was 58.1 ± 11.7 years.The proportion of male and female was similar;the patients with COPD were in mild(41.9%)and moderate(39.2%),the patients with asthma were in partial control state(67.0%);the patients with COPD were in mild to moderate impairment(51.1%).2.Development of adherence assessment tool for patients with chronic airway disease There are 20 items in the compliance questionnaire for the treatment of inhaled drugs in patients with chronic airway diseases,including two parts: dose compliance and inhalation technical specifications.The total CVI of the questionnaire was 0.99,the Cronbach's ? coefficient of each item was 0.723,and the retest coefficient was 0.933(P < 0.01).3.adherence status of inhaled medication in patients with chronic airway disease The total score of patients with chronic airway disease was 88.53 ± 8.21 points,including 48.24 ± 5.38 points for dose adherence and 40.28 ± 4.62 points for inhalation technical specification.The total adherence score of asthmatic patients was89.74 ± 7.27 points,including 48.37 ± 5.42 points for dose adherence,41.37 ± 3.70 points for inhalation technical specification,86.80 ± 9.16 points for COPD patients,including 48.07 ± 5.34 points for dose adherence and 38.73 ± 5.34 points for inhalation technical specification.The adherence of the patients with chronic airway disease is in the middle level,of which the dose adherence is better,but the technical specification of inhalation is poor.4.Analysis of the influencing factors of the adherence of inhalation therapy The results of single factor analysis showed that the factors influencing the adherence of asthma patients with inhalation therapy were living conditions,inhalation therapy time and course of disease(P < 0.05);the factors influencing the adherence of COPD patients with inhalation therapy were employment,smoking and disease severity(P <0.05).Univariate linear regression showed that there was no significant difference between asthma and COPD patients in terms of their adherence with inhalation therapy(P > 0.05).The results of multiple linear regression analysis showed that the correlation coefficient between the course of asthma and the adherence of inhalation treatment was-1.679(P < 0.001),indicating that the longer the course of asthma,the worse the adherence of inhalation treatment;the correlation coefficient between the severity of COPD and the adherence of inhalation treatment was-4.752(P = 0.001),indicating that the more serious the condition of COPD,the worse the adherence of inhalation treatment.Conclusion:1.The questionnaire has good reliability and validity.2.The adherence of patients with chronic airway disease needs to be improved,especially the technical standardization of inhalation.3.The risk factors of non-adherence of asthma inhalation therapy are living alone and long duration.The effect of inhalation therapy time on the adherence of asthma patients is nonlinear.The risk factors of non-adherence of inhalation therapy in COPD patients were occupation,smoking and serious illness.