Elliott Rachel A, Ross-Degnan Dennis, Adams Alyce S, Safran Dana Gelb, Soumerai Stephen B
School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom.
J Gen Intern Med. 2007 Jun;22(6):805-10. doi: 10.1007/s11606-007-0193-5. Epub 2007 Apr 5.
Increasing numbers of medicines increase nonadherence. Little is known about how older adults manage multiple medicines for multiple illnesses.
To explore how older adults with multiple illnesses make choices about medicines.
Semistructured interviews with older adults taking several medications. Accounts of respondents' medicine-taking behavior were collected.
Twenty community-dwelling seniors with health insurance, in Eastern Massachusetts, aged 67-90, (4-12 medicines, 3-9 comorbidities).
Qualitative analysis using constant comparison to explain real choices made about medicines in the past ("historical") and hypothetical ("future") choices.
Respondents reported both past ("historical") choices and hypothetical ("future") choices between medicines. Although people discussed effectiveness and future risk of the disease when prompted to prioritize their medicines (future choices), key factors leading to nonadherence (historical choices) were costs and side effects. Specific choices were generally dominated by 1 factor, and respondents rarely reported making explicit trade-offs between different factors. Factors affecting 1 choice were not necessarily the same as those affecting another choice in the same person. There was no evidence of "adherent" personalities.
Prescribing a new medicine, a change in provider or copayment can provoke new choices about both new and existing medications in older adults with multiple morbidities.
药物数量的增加导致用药依从性降低。关于老年人如何管理多种疾病的多种药物，我们知之甚少。
探讨患有多种疾病的老年人如何选择药物。
对服用多种药物的老年人进行半结构化访谈。收集受访者用药行为的描述。
马萨诸塞州东部20名有医疗保险的社区居住老年人，年龄在67 - 90岁之间，（服用4 - 12种药物，患有3 - 9种合并症）。
采用持续比较的定性分析方法，以解释过去（“历史”）和假设（“未来”）药物选择的实际情况。
受访者报告了过去（“历史”）和假设（“未来”）的药物选择。尽管人们在被要求对药物进行优先级排序时（未来选择）会讨论疾病的有效性和未来风险，但导致不依从（历史选择）的关键因素是成本和副作用。具体选择通常由一个因素主导，受访者很少报告在不同因素之间进行明确的权衡。影响一个选择的因素不一定与影响同一个人另一个选择的因素相同。没有证据表明存在“依从性强”的性格。
开具新药、更换医疗服务提供者或自付费用的变化，可能会促使患有多种疾病的老年人对新药和现有药物做出新的选择。
