Physician trust and depression influence adherence to factor replacement: a single-centre cross-sectional study.
BACKGROUND
Poor adherence to factor replacement therapy among patients with haemophilia can lead to joint bleeding and eventual disability.


OBJECTIVE
The aim of this study was to determine patient-related characteristics associated with adherence to factor replacement in adults with haemophilia.


METHODS
Adults with haemophilia were recruited to participate in this cross-sectional study. Adherence was measured using either the Validated Hemophilia Regimen Treatment Adherence Scale (VERITAS)-Pro or the VERITAS-PRN questionnaire. Simple and multiple regression analyses that controlled for confounding were performed to determine the association between patient-related characteristics and adherence to factor replacement therapy.


RESULTS
Of the 99 subjects enrolled, all were men; 91% had haemophilia A and 78% had severe disease. Age ranged from 18 to 62 years. Most (95%) had functional health literacy; but only 23% were numerate. Mean adherence scores were 45.6 (SD 18) and 51.0 (SD 15) for those on a prophylactic and those on an episodic regimen, respectively, with a lower score indicating better adherence. On multivariable analysis, being on any chronic medication, longer duration followed at our haemophilia treatment centre, higher physician trust and better quality of life were associated with higher adherence. A history of depression was associated with lower adherence.


CONCLUSIONS
Two potentially modifiable characteristics, physician trust and depression, were identified as motivator and barrier to adherence to factor replacement therapy. Promoting a high level of trust between the patient and the healthcare team as well as identifying and treating depression may impact adherence to factor replacement therapy and accordingly reduce joint destruction.
Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA.|Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
D Q
DQ
Tran
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
V
V
Barry
Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA.
A
A
Antun
Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA.
M
M
Ribeiro
Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA.
S
S
Stein
Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA.|Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
C L
CL
Kempton
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression; D005260:Female; D006467:Hemophilia A; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations / Q000941:ethics*; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
adherence; depression; haemophilia; numeracy; physician trust; quality of life
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