Diabetes oral medication initiation and intensification: patient views compared with current treatment guidelines.
Diabetes oral medication initiation and intensification: patient views compared with current treatment guidelines.
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DOI：
10.1177/0145721710388427
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发表时间：
2011-01
期刊：
影响因子：
--
通讯作者：
Park ER
中科院分区：
文献类型：
--
作者：
Grant RW;Pabon-Nau L;Ross KM;Youatt EJ;Pandiscio JC;Park ER
本研究的目的是将患者对药物管理的看法与美国糖尿病协会 (ADA) 发布的治疗算法的基本原则进行比较。对 50 名 2 型糖尿病患者进行了 6 个焦点小组（4 个英语小组和 2 个西班牙语小组）。患者被询问他们之前开始和改变口服药物的经历。他们还看到了针对一名假设患者的药物治疗计划，该计划描述了未来实现血糖控制的潜在变化。编码反应被映射到 ADA 推荐治疗算法中隐含的 3 个概念：(1) 开药以实现 A1c 目标是有益的，(2) 医疗方案通常会强化，(3) 强化应及时。患者的看法与治疗方案形成鲜明对比：（1）大多数患者对开始用药持负面看法，认为这一事件是个人失败和负担增加的证据； (2) 患者将药物强化等同于糖尿病相关并发症的风险增加（而不是降低未来风险的步骤），并将降级视为首要目标； (3) 没有患者对药物强化延迟表示担忧。患者对描绘未来潜在变化的个体化用药计划反应非常积极。这项研究中的患者描述了一种药物治疗的概念模型，该模型与当前治疗指南的原则形成了关键的对比。研究结果强调了医患沟通的关键作用，表明有效的咨询还应包括对未来药物强化的知情讨论。
The purpose of this study was to compare patient perceptions about medication management to principles underlying American Diabetes Association (ADA) published treatment algorithms. Six focus groups (4 English and 2 Spanish) were conducted with 50 patients with type 2 diabetes. Patients were asked about their prior experiences with initiating and changing oral medicines. They were also shown a medication plan for a hypothetical patient depicting future potential changes to achieve glycemic control. Coded responses were mapped to 3 concepts implicit in the ADA recommended treatment algorithm: (1) prescribing medicines to achieve A1c goal is beneficial, (2) medical regimens are generally intensified, and (3) intensification should be timely. Patient perceptions contrasted markedly with the treatment algorithm: (1) most patients had negative perceptions of medication initiation, viewing this event as evidence of personal failure and an increased burden; (2) patients equated medication intensification with increased risk for diabetes-related complications (rather than a step to reduce future risk) and viewed de-escalation as a primary goal; and (3) no patients expressed concerns about delays in medication intensification. Patients responded very favorably to an individualized medication plan depicting future potential changes. Patients in this study described a conceptual model for medication therapy that contrasted in critical ways from the principles of current treatment guidelines. Underscoring the key role of patient-provider communication, the results suggest that effective counseling should also include an informed discussion of future medication intensification.
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影响因子：
16.2
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