Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study
Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study
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DOI：
10.1182/bloodadvances.2020001701
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发表时间：
2020-09-22
期刊：
影响因子：
7.5
通讯作者：
Porter, Jerlym
中科院分区：
文献类型：
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作者：
Hodges, Jason R.;Phillips, Shannon M.;Porter, Jerlym
羟基脲是治疗镰状细胞病(SCD)的有效方法，但SCD患者的采用率较低。这项研究的目的是通过使用有意和无意的药物不依从性框架来检查患者遵守羟基脲使用方案的障碍。我们采访了年龄在15到49.9岁的SCD患者，他们是镰状细胞疾病实施联盟(SCDIC)需求评估的参与者。有意和无意的药物不依从性框架解释了使用羟基尿素的障碍，并增加了对SCD人群特有的药物依从性障碍的理解。总共完成了8个SCDIC站点中的5个站点的90个半结构化访谈。在受访参与者中，57.8%(n=52)的人目前正在服用羟基脲，28.9%(n=26)的人在访谈时曾服用羟基脲，13.3%(n=12)的人从未使用过羟基脲，但熟悉这种药物。运用建构主义扎根理论的方法，我们发现了导致羟基尿素不依附的重要主题，这些主题被归类为无意(如健忘、外部影响因素)和有意(对羟基尿素的负面看法、对任何药物的厌恶)不依附类型。参与者更频繁地支持属于无意不依从型(70%)的依从性障碍，而不是故意不依从型(30%)。这项研究的结果将帮助SCD医疗保健提供者了解患者的选择和决定是无意的还是有意的，指导关于羟基尿素治疗的量身定制的临床讨论，并开发具体的、更细微的干预措施来解决不依从性因素。
Hydroxyurea is an efficacious treatment for sickle cell disease (SCD), but adoption is low among individuals with SCD. The objective of this study was to examine barriers to patients' adherence to hydroxyurea use regimens by using the intentional and unintentional medication nonadherence framework. We interviewed individuals with SCD age 15 to 49.9 years who were participants in the Sickle Cell Disease Implementation Consortium (SCDIC) Needs Assessment. The intentional and unintentional medication nonadherence framework explains barriers to using hydroxyurea and adds granularity to the understanding of medication adherence barriers unique to the SCD population. In total, 90 semi-structured interviews were completed across 5 of the 8 SCDIC sites. Among interviewed participants, 57.8% (n = 52) were currently taking hydroxyurea, 28.9% (n = 26) were former hydroxyurea users at the time of the interview, and 13.3% (n = 12) had never used hydroxyurea but were familiar with the medication. Using a constructivist grounded theory approach, we discovered important themes that contributed to nonadherence to hydroxyurea, which were categorized under unintentional (eg, Forgetfulness, External Influencers) and intentional (Negative Perceptions of Hydroxyurea, Aversion to Taking Any Medications) nonadherence types. Participants more frequently endorsed adherence barriers that fell into the unintentional nonadherence type (70%) vs intentional nonadherence type (30%). Results from this study will help SCD health care providers understand patient choices and decisions as being either unintentional or intentional, guide tailored clinical discussions regarding hydroxyurea therapy, and develop specific, more nuanced interventions to address nonadherence factors.