Taking less than prescribed: medication nonadherence and provider-patient relationships in lower-income, rural minority adults with hypertension.
Taking less than prescribed: medication nonadherence and provider-patient relationships in lower-income, rural minority adults with hypertension.
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DOI：
10.1111/j.1751-7176.2010.00321.x
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发表时间：
2010-09
期刊：
影响因子：
--
通讯作者：
Pisu M
中科院分区：
文献类型：
--
作者：
Martin MY;Kohler C;Kim YI;Kratt P;Schoenberger YM;Litaker MS;Prayor-Patterson HM;Clarke SJ;Andrews S;Pisu M
高血压的控制情况仍然不佳，不遵医嘱服药被认为是一个主要原因。很少有研究调查非洲裔美国人、低收入的农村成年人在无需个人付费获取药物的情况下不遵医嘱服药的原因。此外，我们对于医患关系如何影响这一人群的服药依从性的了解有限。在这项研究中，作者（1）研究了比规定剂量少服药的原因，（2）研究了医患相关变量与服药依从性之间的关联。共纳入434名参与者（94.8%为非洲裔美国人）。比规定剂量少服药最常被认可的原因是到服药时间时没有降压药（36%）、药吃完了（35%）、受到副作用困扰（29%）以及日常生活规律改变（27%）。不依从的个体明显更有可能报告向医疗服务提供者提问时感到不自在（74%对63%），更有可能报告就医有压力（25%对16%），并且表现出更多的抑郁症状（58%对45%）。依从的患者血压更低（收缩压：133±15.8毫米汞柱对138±17.6毫米汞柱，P值 = 0.002；舒张压：80±9.8毫米汞柱对83±11毫米汞柱，P值 = 0.003）。为农村贫困高血压患者提供医疗服务的临床医生应该常规评估自我管理行为、后勤障碍和心理健康。创造能将就医压力降至最低并鼓励患者提问的临床诊疗环境，对于高血压的最佳管理可能也很重要。
Control of hypertension remains poor, and lack of adherence to medication is considered a primary reason. Few studies have examined the reasons for medication nonadherence in African American, lower-income, rural adults receiving medications at no personal cost. Moreover, our understanding of how the provider-patient relationship influences adherence in this population is limited. In this study, the authors (1) examined reasons for taking less medication than prescribed and (2) examined the association between provider-patient variables and medication adherence. A total of 434 participants (94.8% African American) were included. The most frequently endorsed reasons for taking less medication than prescribed were not having blood pressure medicine when it was time to take a dose (36%), running out of medicine (35%), bothered by side effects (29%), and a change in one’s daily routine (27%). Nonadherent individuals were significantly more likely to report discomfort with asking the health provider questions (74% vs 63%), were more likely to report that health care visits were stressful (25% vs 16%), and exhibited more depressive symptoms (58% vs 45%). Adherent patients had lower blood pressure (systolic: 133±15.8 mm Hg vs 138±17.6 mm Hg, P value=.002; diastolic: 80±9.8 mm Hg vs 83±11 mm Hg, P value=.003) than individuals who were less adherent. Clinicians providing care to rural, poor hypertensive patients should routinely assess self-management behaviors, logistical barriers, and emotional health. Creating clinical encounters that minimize the stressful nature of the visit and encourage patient question-asking behavior may also be important for the optimal management of hypertension.
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