Help needed in medication self-management for people with visual impairment: case-control study
Help needed in medication self-management for people with visual impairment: case-control study
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DOI：
10.3399/bjgp12x653570
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发表时间：
2012-08-01
影响因子：
5.9
通讯作者：
Cupples, Margaret E.
中科院分区：
文献类型：
--
作者：
McCann, Roseleen M.;Jackson, A. Jonathan;Cupples, Margaret E.
背景：视力损害(VI)的患病率正在上升，并导致发病率的增加，特别是在老年人中。了解患者的问题是获得最佳健康结果的基础，但关于VI如何影响药物自我管理的研究知之甚少。目的：比较有VI和没有VI的老年人的药物自我管理问题。设计和背景：病例对照研究，参与者=65岁，每天至少开两次长期口服药物，生活在社区内。方法：研究招募了156名低视力诊所的VI患者(最佳矫正视力[BCVA]6/18至3/60)；社区验光师确定了158名对照(BCVA 6/9或更高)。研究人员走访了参与者的家中，填写了两份有效的问卷来评估服药依从性(Morisky；药物依从性报告量表[MARS])，并询问了有关药物自我管理、信念和支持的问题。结果：两组参与者中约有一半报告在两份问卷上都完全遵守(52.5%的Morisky；43.3%的MARS)。尽管使用了光学辅助设备，但极少数(3%)的VI患者能够清楚地阅读药物信息；24%的患者难以区分不同的药片。患有VI的人(29%)比对照组(13%)(优势比[OR]=2.8；95%可信区间[CI]=1.6至5.0)更需要朋友(19%对10%)或药剂师(10%对2.5%；OR=4.4，95%CI=1.4至13.5)的帮助来管理他们的药物；更多的人接受社会服务支持(OR=7.1；95%CI=3.9~12.9)。结论：与没有VI的同龄人相比，患有VI的老年人在管理药物方面需要帮助的可能性是同龄人的两倍以上。在初级保健的临床实践中，必须认识到病人在接受处方治疗时需要实际支持。应探索有效的用药自我管理策略。
Background:Visual impairment (VI) is rising in prevalence and contributing to increasing morbidity, particularly among older people. Understanding patients' problems is fundamental to achieving optimal health outcomes but little is known about how VI impacts on self-management of medication.Aim:To compare issues relating to medication self-management between older people with and without VI.Design and setting:Case-control study with participants aged =65 years, prescribed at least two long-term oral medications daily, living within the community.Method:The study recruited 156 patients with VI (best corrected visual acuity [BCVA] 6/18 to 3/60) at low-vision clinics; community optometrists identified 158 controls (BCVA 6/9 or better). Researchers visited participants in their homes, administered two validated questionnaires to assess medication adherence (Morisky; Medication Adherence Report Scale [MARS]), and asked questions about medication self-management, beliefs, and support.Results:Approximately half of the participants in both groups reported perfect adherence on both questionnaires (52.5% Morisky; 43.3%, MARS). Despite using optical aids, few (3%) with VI could read medication information clearly; 24% had difficulty distinguishing different tablets. More people with VI (29%) than controls (13%) (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.6 to 5.0) needed help managing their medication, from friends (19% versus 10%) or pharmacists (10% versus 2.5%; OR = 4.4, 95% CI = 1.4 to 13.5); more received social service support (OR = 7.1; 95% CI = 3.9 to 12.9).Conclusion:Compared to their peers without VI, older people with VI are more than twice as likely to need help in managing medication. In clinical practice in primary care, patients' needs for practical support in taking prescribed treatment must be recognised. Strategies for effective medication self-management should be explored.