Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low-income patients with hypertension: a qualitative study.
Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low-income patients with hypertension: a qualitative study.
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评估患者和医务人员对治疗药物监测的态度，以提高低收入高血压患者的服药依从性：一项定性研究。
DOI：
10.1136/bmjopen-2020-039940
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发表时间：
2020-11-27
期刊：
影响因子：
2.9
通讯作者：
Vongpatanasin W
中科院分区：
文献类型：
--
作者：
Schesing KB;Chia R;Elwood B;Halm EA;Lee SJC;Lodhi H;Wu B;Sharma S;Smith SA;Jarrett RB;Das SR;Vongpatanasin W
以前的研究表明，治疗性药物监测(TDM)通过测量血清或尿药浓度，是一种高度可靠的检测药物不依从性的技术，但以前还没有评估过患者和医生对TDM的态度。因此，我们征求了未得到控制的高血压患者及其医生对TDM的看法。在半结构化面试中对一组问题的回答进行前瞻性分析。在一个为低收入、未参保人口提供护理的综合卫生系统中提供门诊服务。在普通心脏病和内科诊所使用抗高血压药物或提供降压药的情况下，有无控制的高血压患者的收缩压至少130毫米汞柱或舒张压至少80毫米汞柱。对TDM的态度及其对医患关系的潜在影响。我们采访了11名患者和10名提供者，并与13名社区咨询小组(CAP)成员讨论了调查结果。在接受采访的患者中，91%(11人中的10人)和所有10名提供者都认为TDM是一个好主意，应该定期使用，以更好地了解高血压控制不佳的原因。然而，63%(7/11)的患者和20%的提供者表示保留意见，认为TDM会对医患关系产生负面影响。尽管存在一些担忧，但大多数患者、提供者和CAP成员认为，如果在不指责患者的情况下传达测试结果，TDM在识别次优依从性和引发依从性障碍方面的潜在好处超过了风险。TDM的想法被患者和他们的提供者很好地接受。TDM信息如果以非评判的方式提供，以鼓励患者和医生之间的诚实对话，就有可能减少患者与医生之间的沟通障碍，并确定坚持下去的障碍，当克服这些障碍时，可以改善健康结果。
Previous studies have implicated therapeutic drug monitoring (TDM), by measuring serum or urine drug levels, as a highly reliable technique for detecting medication non-adherence but the attitudes of patients and physicians toward TDM have not been evaluated previously. Accordingly, we solicited input from patients with uncontrolled hypertension and their physicians about their views on TDM. Prospective analysis of responses to a set of questions during semistructured interviews. Outpatient clinics in an integrated health system which provides care for a low-income, uninsured population. Patients with uncontrolled hypertension with either systolic blood pressure of at least 130 mm Hg or diastolic blood pressure of at least 80 mm Hg despite antihypertensive drugs and providers in the general cardiology and internal medicine clinics. Attitudes towards TDM and the potential impact on physician–patient relationship. We interviewed 11 patients and 10 providers and discussed the findings with 13 community advisory panel (CAP) members. Of the patients interviewed, 91% (10 of 11) and all 10 providers thought TDM was a good idea and should be used regularly to better understand the reasons for poorly controlled hypertension. However, 63% (7 of 11) of patients and 20% of providers expressed reservations that TDM could negatively impact the physician–patient relationship. Despite some concerns, the majority of patients, providers and CAP members believed that if test results are communicated without blaming patients, the potential benefits of TDM in identifying suboptimal adherence and eliciting barriers to adherence outweighed the risks. The idea of TDM is well accepted by patients and their providers. TDM information if delivered in a non-judgmental manner, to encourage an honest conversation between patients and physicians, has the potential to reduce patient–physician communication obstacles and to identify barriers to adherence which, when overcome, can improve health outcomes.
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影响因子：
5.4
作者：
Zeller, Andreas;Taegtmeyer, Anne;Tschudi, Peter
通讯作者：
Tschudi, Peter
影响因子：
105.7
作者：
Vrijens, Bernard;Vincze, Gabor;Burnier, Michel
通讯作者：
Burnier, Michel
影响因子：
3.2
作者：
Creswell, JW;Miller, DL
通讯作者：
Miller, DL
影响因子：
3
作者：
Feyz, Lida;Bahmany, Soma;Versmissen, Jorie
通讯作者：
Versmissen, Jorie
DOI：
10.1111/jch.12570
发表时间：
2015-09
期刊：
Journal of clinical hypertension (Greenwich, Conn.)
影响因子：
--
作者：
Velasco A;Chung O;Raza F;Pandey A;Brinker S;Arbique D;Price A;Lotan Y;Das SR;Vongpatanasin W
通讯作者：
Vongpatanasin W