Garcia Popa-Lisseanu Maria G, Greisinger Anthony, Richardson Marsha, O'Malley Kimberly J, Janssen Namieta M, Marcus Donald M, Tagore Jasmeet, Suarez-Almazor Maria E
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
J Rheumatol. 2005 May;32(5):913-9.
To explore the determinants of adherence to medical recommendations, including drug therapy and appointment-keeping, among ethnically diverse and economically disadvantaged patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
Patients with RA and SLE were identified through chart review and were invited to participate in focus groups to examine their attitudes and beliefs regarding adherence to treatment and medical appointments. Eight focus groups (4 RA, 4 SLE) were conducted, with a total of 40 participants (22 SLE patients and 18 RA patients). Transcripts were analyzed using grounded theory techniques and qualitative analysis software to facilitate coding interpretation.
The majority of participants reported experiencing difficulty in adhering to their treatment at least occasionally. Both SLE and RA patients reported similar barriers to treatment adherence: fear of side effects, financial problems, difficulty in navigating the public health system, and perceived treatment inefficacy. RA and SLE patients also revealed barriers to appointment keeping, including difficulties in scheduling, financial costs, transportation, and functional impairment limiting their ability to attend the clinic.
Patients' perceptions of and experiences with the health system, physicians, medication effectiveness, and side effects influence their adherence to treatment and other medical recommendations. Strategies to improve adherence could include the following: attempting to modify patients' beliefs and perceptions regarding medication effectiveness, promoting realistic expectations about risk/benefit ratios, and improving access to health care by reducing barriers that limit the interaction between patients and the health system.
探讨在患有类风湿性关节炎（RA）和系统性红斑狼疮（SLE）的不同种族且经济处于不利地位的患者中，坚持药物治疗和按时就诊等医疗建议的决定因素。
通过病历审查确定患有RA和SLE的患者，并邀请他们参加焦点小组，以检查他们对坚持治疗和按时就诊的态度及信念。共进行了8个焦点小组（4个RA组，4个SLE组），共有40名参与者（22名SLE患者和18名RA患者）。使用扎根理论技术和定性分析软件对转录本进行分析，以促进编码解释。
大多数参与者报告至少偶尔在坚持治疗方面存在困难。SLE和RA患者报告的治疗依从性障碍相似：对副作用的恐惧、经济问题、在公共卫生系统中就医困难以及认为治疗无效。RA和SLE患者还揭示了按时就诊的障碍，包括安排时间困难、经济成本、交通问题以及功能障碍限制了他们前往诊所就诊的能力。
患者对医疗系统、医生、药物疗效和副作用的认知及体验会影响他们对治疗和其他医疗建议的依从性。提高依从性的策略可包括以下方面：尝试改变患者对药物疗效的信念和认知，促进对风险/效益比的现实期望，并通过减少限制患者与医疗系统互动的障碍来改善医疗服务的可及性。
