Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives
Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives
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DOI：
10.1002/acr.23202
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发表时间：
2017-11-01
影响因子：
4.7
通讯作者：
Ivankova, Nataliya
中科院分区：
文献类型：
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作者：
Singh, Jasvinder A.;Herbey, Ivan;Ivankova, Nataliya
目的探讨痛风自我管理和相关的挑战和解决方案，在AfricanAmerican.MethodsWe进行了半结构化的采访与35名非洲裔美国退伍军人痛风，谁收到的医疗保健在伯明翰或费城退伍军人事务部（VA）的医疗中心，填补了降尿酸治疗（尿酸，最常见的别嘌呤醇）至少6个月，并有一个非裔美国人的药物占有率80%。访谈协议的构建是为了探讨与痛风自我管理相关的关键概念，包括痛风的初步诊断，痛风的开始医疗护理，痛风的过程，痛风药物治疗的依从性，饮食策略，合并症和副作用，以及社会支持。（最常见的是别嘌呤醇）在伯明翰（n = 18）或费城（n = 17）VA医疗中心接受了采访。平均年龄为65岁，平均体重指数为31.9 kg/m2，97%患有高血压，23%患有冠状动脉疾病，31%患有肾衰竭。激励非裔美国退伍军人更好地进行痛风自我管理的主要主题是对疼痛的恐惧，坚持服药，自律，生活方式的改变，信息收集和发展积极的前景。伯明翰的参与者更频繁地透露跳过痛风药物。更多的费城参与者讨论了生活方式/饮食的变化，以防止痛风发作，表示限制社会活动，涉及饮酒，并寻求更多的信息痛风自我管理从卫生保健提供者和互联网sources.ConclusionIdentified主题，包括文化差异的网站，导致了以患者为中心的干预措施，以改善痛风自我管理的非洲裔美国男性痛风。
ObjectiveTo explore gout self-management and associated challenges and solutions in African Americans.MethodsWe conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio 80%. The interview protocol was constructed to explore key concepts related to gout self-management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support.ResultsThirty-five African American male veterans with gout who had 80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m(2), 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self-management were fear of pain, adherence to medications, self-discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and internet sources.ConclusionIdentified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African American men with gout.