Reasons for adherence with antihypertensive medication
Reasons for adherence with antihypertensive medication
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DOI：
10.1016/s0167-5273(00)00374-0
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发表时间：
2000-11-01
影响因子：
3.5
通讯作者：
Säljö, R
中科院分区：
文献类型：
--
作者：
Svensson, S;Kjellgren, KI;Säljö, R
背景：在临床实践中，高血压常常控制不佳，一个主要原因是患者对治疗的依从性差。对于依从性差的根本原因知之甚少。我们着手调查高血压患者自述的遵循或忽视抗高血压药物治疗建议的原因。
方法：对瑞典南部一个全科医疗中心和一个高血压专科病房的33名高血压患者进行半结构化访谈的定性分析。同时进行了血压测量和抗高血压药物的实验室检测。
结果：33名患者中有19名被归类为依从性良好。依从性是对医生的信任、对高血压并发症的恐惧以及控制血压的愿望的函数。不依从是一种主动的决定，部分基于对病情的误解和对药物的普遍不认可，但主要是为了方便日常生活或减少不良反应。依从性好的患者比不依从的患者在参与治疗方面表现出的证据更少。自述的依从性、依从性的实验室指标和血压水平之间没有明显的关系。
结论：访谈是确定患者观念和行为的有力工具。为了优化高血压的治疗，建立一种治疗联盟至关重要，在这种联盟中，患者对治疗的疑虑和困难能够被发现和解决。为此，有效的医患沟通至关重要。（C）2000爱思唯尔爱尔兰科学有限公司。保留所有权利。
Background: Hypertension is often insufficiently controlled in clinical practice, a prominent reason for this being poor patient adherence with therapy. Little is known about the underlying reasons for poor adherence. We set out to investigate hypertensive patients' self-reported reasons for adhering to or ignoring medical advice regarding antihypertensive medication. Methods: Qualitative analysis of semi-structured interviews with 33 hypertensive patients in a general-practice centre and a specialist hypertension unit in Southern Sweden. Blood-pressure measurements and laboratory measurements of antihypertensive medication were performed. Results: Nineteen out of 33 patients were classified as adherent. Adherence was a function of faith in the physician, fear of complications of hypertension, and a desire to control blood pressure. Non-adherence was an active decision, partly based on misunderstandings of the condition and general disapproval of medication, but mostly taken in order to facilitate daily life or minimize adverse effects. Adherent patients gave less evidence of involvement in care than non-adherent patients. There was no obvious relation between reported adherence, laboratory markers of adherence and blood-pressure levels. Conclusions: The interview is a powerful tool for ascertaining patients' concepts and behaviour. To optimize treatment of hypertension, it is important to form a therapeutic alliance in which patients' doubts and difficulties with therapy can be detected and addressed. For this, effective patient-physician communication is of vital importance. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.