Introduction: Medication adherence is essential for treatment and recovery following hematopoietic stem cell transplantation (HSCT). However, limited data exist on the most effective methods to measure adherence and the factors influencing it in HSCT patients.Materials and Methods: A prospective longitudinal study assessed immunosuppressant medication adherence in 150 patients with hematologic malignancies undergoing allogeneic HSCT. Adherence was assessed using pill counts, immunosuppressant medication levels, patient-reported medication logs, and the Medication Adherence Response Scale-5 (MARS-5) at 30, 100, and 180 days post-HSCT. We evaluated adherence rates, agreement between methods, and sociodemographic and clinical predictors. From patient-reported logs, we calculated dose adherence (comparing reported doses to expected doses) and timing adherence (comparing medication intake within ±3 h of the prescribed time). Kappa analysis assessed agreement among methods.Results: Of 190 eligible patients, 150 (78.9%) enrolled. The mean age was 57.5 years (SD = 13.5); 41.3% (n = 62) were female, 85.3% (n = 128) were non-Hispanic White, and 73.3% (n = 110) were married or living with a partner. Medication adherence varied across the three timepoints and by measurement type: 52–64% (pill counts), 18–24% (medication levels), 96–98% (medication log dose adherence), 83–84% (medication log timing adherence), and 97–98% (MARS−5). There was minimal agreement between measures (Kappa range: 0.008–0.12).Conclusions: Despite the feasibility of leveraging objective and patient-reported measures to assess medication adherence in HSCT patients, there was little agreement between these measures. Patient-reported measures showed high adherence, while objective measures like pill counts and medication levels revealed more modest adherence. The complexity of medication regimens likely contributes to this discrepancy. A rigorous approach to understanding medication adherence in the HSCT population may entail both objective and subjective measures of medication adherence.
引言：药物依从性对造血干细胞移植（HSCT）后的治疗与康复至关重要。然而，目前关于HSCT患者药物依从性最有效的测量方法及其影响因素的数据仍较为有限。 材料与方法：本研究采用前瞻性纵向设计，对150例接受异基因HSCT的血液恶性肿瘤患者进行免疫抑制剂药物依从性评估。分别在移植后30天、100天和180天，通过药片计数、免疫抑制剂血药浓度监测、患者自报用药记录以及药物依从性反应量表-5（MARS-5）进行评估。我们分析了依从率、不同测量方法间的一致性，以及社会人口学和临床预测因素。根据患者自报记录，计算剂量依从性（比较报告剂量与预期剂量）和时间依从性（比较实际服药时间与规定时间±3小时内的符合程度）。采用Kappa分析评估各方法间的一致性。 结果：在190例符合条件患者中，150例（78.9%）纳入研究。平均年龄57.5岁（标准差=13.5）；女性占41.3%（n=62），非西班牙裔白人占85.3%（n=128），已婚或同居者占73.3%（n=110）。药物依从性在三个时间点及不同测量方式间存在差异：药片计数显示52-64%依从性，血药浓度监测显示18-24%，用药记录剂量依从性为96-98%，用药记录时间依从性为83-84%，MARS-5量表显示97-98%。各测量方法间一致性较低（Kappa值范围：0.008-0.12）。 结论：尽管采用客观测量与患者自报相结合的方法评估HSCT患者药物依从性具有可行性，但不同测量方式间一致性较低。患者自报测量显示高依从性，而药片计数和血药浓度监测等客观测量则显示依从性相对有限。药物治疗方案的复杂性可能是造成这种差异的原因。要深入理解HSCT人群的药物依从性，可能需要同时采用客观与主观相结合的测量方法。
Medication Adherence in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation
肿瘤(癌症)患者之家