Optimisation of secondary prevention of stroke: a qualitative study of stroke patients' beliefs, concerns and difficulties with their medicines.
Optimisation of secondary prevention of stroke: a qualitative study of stroke patients' beliefs, concerns and difficulties with their medicines.
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DOI：
10.1111/ijpp.12104
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发表时间：
2014-12-01
期刊：
影响因子：
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通讯作者：
Mead, Gillian
中科院分区：
文献类型：
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作者：
Souter, Caroline;Kinnear, Anne;Mead, Gillian
目的：探讨卒中患者和照顾者对药物的信念和关注，找出继发性卒中预防用药依从性的障碍。方法：对30例确诊为卒中的患者进行定性、半结构化的一对一访谈。访谈使用框架方法进行分析。KEY发现：这项研究表明，中风患者和照顾者对他们的药物的看法可能会影响服药行为。在某些情况下，当信念超过担忧时，实际障碍会阻止参与者服用药物。对一种药物的负面信念足够强烈，足以阻止一些参与者开始服用新药。参与者的行为受到不服药的感知后果和不良影响对其生活质量的影响。担忧随着时间的推移而减少，没有任何不利影响。护理员的作用和服药程序的重要性是显而易见的。与会者报告说，提供的信息不足，希望获得更多的书面和口头信息。一些人报告在出院后完全缺乏与他们的全科医生或社区药剂师的联系。结论：中风患者遵循二级预防策略的许多困难是潜在的可以预防的，只要提供量身定制的信息，并由初级保健专业人员进行适当的监测和随访。我们设计了一种干预措施，解决了已确定的服药障碍，目前正在对中风患者进行药剂师主导的家庭临床用药审查的随机对照试验中衡量其影响。
OBJECTIVES: The objectives of this study are to explore stroke patients' and carers' beliefs and concerns about medicines and identify the barriers to medication adherence for secondary stroke prevention.METHODS: Qualitative semistructured one-on-one interviews were conducted with 30 patients with diagnosis of stroke. Interviews were analysed using the framework approach.KEY FINDINGS: The study suggests that stroke patients' and carers' perceptions of their medicines may influence medicine-taking behaviour. In some cases when beliefs outweighed concerns, practical barriers prevented participants taking their medicines. Negative beliefs about a medicine were strong enough to prevent some participants starting a new medicine. Participants' actions were influenced by the perceived consequences of not taking the medicine and the impact of the adverse effect on their quality of life. Concerns lessened with time with no adverse effects. The importance of the role of the carer and of a medicine-taking routine was evident. Participants reported the inadequacy of information provision and the desire to have more written and verbal information. Some reported total lack of contact with their general practitioner or community pharmacist after hospital discharge.CONCLUSIONS: Many of the difficulties stroke patients have adhering to secondary prevention strategies are potentially preventable with tailored information provision and appropriate monitoring and follow-up by primary healthcare professionals. We have designed an intervention addressing the identified barriers to medicine taking, the impact of which is currently being measured in a randomised controlled trial of a pharmacist-led home-based clinical medication review in stroke patients.