Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study.
Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study.
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DOI：
10.1053/j.ajkd.2010.04.021
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发表时间：
2010-09
期刊：
影响因子：
--
通讯作者：
Wilson IB
中科院分区：
文献类型：
--
作者：
Rifkin DE;Laws MB;Rao M;Balakrishnan VS;Sarnak MJ;Wilson IB
患有慢性肾病 (CKD) 的老年人通常会服用五种以上的药物，并且有多名处方医生开具处方。然而，人们对他们如何优先考虑自己的医疗状况或决定服用哪些药物却知之甚少。对 20 名患有 CKD 3-5D 期、在三级转诊中心接受肾脏病治疗的社区居民进行半结构化访谈（平均长度 40 分钟）。受访者被问及有关药物、处方医生和服药行为的问题。我们进行了主题分析，以解释患者关于药物优先顺序、理解和依从性决定的决定。参与者（年龄范围，55-84 岁；平均年龄，72 岁）服用 5-14 种处方药，有 2-9 名医生，患有 5-11 种合并症。所有人都给他们的药物分配了隐含的优先顺序。虽然大多数人表示愿意坚持治疗，但许多人经常跳过他们认为不太重要的药物治疗。大多数人确定了每种药物的处方医生和适应症，但对药物的看法与传统医学观点之间往往存在很大差异。受访者根据特定病症的显着性、治疗的感知效果以及服用处方药的障碍（身体、后勤或财务）来优先考虑药物。药物的副作用很常见，而且会引起焦虑，但与处方医生的讨论常常被拖延或令患者不满意。 CKD 患者的多种用药导致该人群复杂的药物选择和依从行为。我们采访的大多数患者都有与传统医学观点不一致的信念或优先事项，但患者很少与医生讨论这些信念和优先事项，或由此导致的不良用药依从性。需要进一步研究以提供有关依从障碍程度的定量数据。关于服药的更有效的沟通可能会改善患者的健康结果并减少潜在的药物不良事件。
Older adults with chronic kidney disease (CKD) typically take more than five medications and have multiple prescribing physicians. Little however is known about how they prioritize their medical conditions or decide which medications to take. Semistructured interviews (average length 40 minutes) with twenty community-dwelling adults with CKD stages 3-5D, receiving nephrology care at a tertiary referral center. Respondents were asked about medications, prescribing physicians, and medication-taking behaviors. We performed thematic analysis to explain patients’ decisions regarding medication prioritization, understanding, and adherence decisions. Participants (age range, 55–84 years; mean, 72) took 5–14 prescribed medications, had 2–9 physicians, and 5–11 comorbid conditions. All had assigned implicit priorities to their medications. While the majority expressed the intention to be adherent, many regularly skipped medications they considered less important. Most identified the prescribing physician and indication for each medication, but there was often substantial discordance between beliefs about medications and conventional medical opinion. Respondents prioritized medications based on the salience of the particular condition, perceived effects of the treatment, and on the barriers (physical, logistic, or financial) to taking the prescribed drug. Side effects of medications were common and anxiety-provoking, but discussions with the prescribing physician were often delayed or unfulfilling for the patient. Polypharmacy in CKD patients leads to complex medication choices and adherence behaviors in this population. Most of the patients we interviewed had beliefs or priorities that were non-concordant with conventional medical opinion, but patients rarely discussed these beliefs and priorities, or the resultant poor medication adherence, with their physicians. Further study is needed to provide quantitative data on the magnitude of adherence barriers. It is likely that more effective communication about medication taking could improve patients’ health outcomes and reduce potential adverse drug events.
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