Supporting adherence to oral anticancer agents: clinical practice and clues to improve care provided by physicians, nurse practitioners, nurses and pharmacists
Supporting adherence to oral anticancer agents: clinical practice and clues to improve care provided by physicians, nurse practitioners, nurses and pharmacists
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DOI：
10.1186/s12885-017-3110-2
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发表时间：
2017-02-10
期刊：
影响因子：
3.8
通讯作者：
Hugtenburg, Jacqueline G.
中科院分区：
文献类型：
--
作者：
Timmers, Lonneke;Boons, Christel C. L. M.;Hugtenburg, Jacqueline G.
背景：医疗保健提供者（HCP）的活动和对患者的态度强烈影响药物依从性。本研究的目的是评估目前的临床实践，以支持患者坚持治疗口服抗癌药（OACA），并探讨线索，以改善药物治疗adherence.Methods的管理：一个横断面，观察性研究之间的HCP（血液）肿瘤设置在比利时和荷兰进行了2014年使用复合问卷。共列出了47项护理活动，并将其分为八个领域。还询问了HCP对依从性管理的看法：对依从性的了解、患者沟通、影响能力、对后果的了解和对原因的了解。验证问卷被用来评估信念的药物治疗（BMQ）和共享决策（SDM-Q-doc）。结果：共208 HCP（29%男性）参加; 107从51荷兰和101从26比利时医院。尽管报告了广泛的活动，但有关药物依从性管理的某些领域受到的关注较少。最常报告与患者知识和不良事件管理相关的活动，而经常遗漏针对患者自我效能和持续使用期间药物依从性的活动。提供的护理因专业和国家而异。比利时医生报告的活动比荷兰医生多，而荷兰护士和药剂师报告的活动比比利时同事多。对药物依从性管理的看法与HCP提供的护理水平有关。SDM和BMQ的结果是不相关的照顾provided.Conclusions：提高认识和观念的药物治疗依从性管理的HCP可能有一个积极的影响护理质量。护理可以通过更直接地解决药物依从性来改善。例如，在一个实施例中，通过询问患者（预期）障碍并讨论克服这些障碍的策略，通过询问错过的剂量并提供（电子）提醒以支持长期药物依从性。建议采用多学科方法，其中药剂师的作用可以扩大。
Background: Healthcare provider (HCP) activities and attitudes towards patients strongly influence medication adherence. The aim of this study was to assess current clinical practices to support patients in adhering to treatment with oral anticancer agents (OACA) and to explore clues to improve the management of medication adherence.Methods: A cross-sectional, observational study among HCPs in (haemato-) oncology settings in Belgium and the Netherlands was conducted in 2014 using a composite questionnaire. A total of 47 care activities were listed and categorised into eight domains. HCPs were also asked about their perceptions of adherence management on the items: insight into adherence, patients' communication, capability to influence, knowledge of consequences and insight into causes. Validated questionnaires were used to assess beliefs about medication (BMQ) and shared decision making (SDM-Q-doc).Results: In total, 208 HCPs (29% male) participated; 107 from 51 Dutch and 101 from 26 Belgian hospitals. Though a wide range of activities were reported, certain domains concerning medication adherence management received less attention. Activities related to patient knowledge and adverse event management were reported most frequently, whereas activities aimed at patient's self-efficacy and medication adherence during ongoing use were frequently missed. The care provided differed between professions and by country. Belgian physicians reported more activities than Dutch physicians, whereas Dutch nurses and pharmacists reported more activities than Belgian colleagues. The perceptions of medication adherence management were related to the level of care provided by HCPs. SDM and BMQ outcomes were not related to the care provided.Conclusions: Enhancing the awareness and perceptions of medication adherence management of HCPs is likely to have a positive effect on care quality. Care can be improved by addressing medication adherence more directly e. g., by questioning patients about (expected) barriers and discussing strategies to overcome them, by asking for missed doses and offering (electronic) reminders to support long-term medication adherence. A multidisciplinary approach is recommended in which the role of the pharmacist could be expanded.