Hughes Carmel M
School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland.
Drugs Aging. 2008;25(6):445-54. doi: 10.2165/00002512-200825060-00001.
Compliance with medication has been frequently cited as a problem for patients living in community settings. However, there has been little commentary on compliance issues for residents in nursing homes. This is probably due to the assumption that residents will receive their medication on a regular basis and administration will be supervised and, therefore, compliance is not perceived to be a problem. However, regular compliance may not always be appropriate if the medication has not been reviewed for appropriateness and this 'enforced' compliance may give rise to side effects or adverse effects. Residents may also be exposed to 'erratic' compliance because of inconvenient administration times for staff or difficult and time-consuming administration instructions. This may have clinical implications for residents who require medication at regular intervals, e.g. those who have Parkinson's disease. Enforced or erratic compliance is at odds with shared decision making, which is being promoted as a way of empowering patients. It could be argued that because of a high degree of cognitive impairment, it is not appropriate for nursing home residents to become involved in decision making about medications. However, the nursing home population is heterogeneous in nature and the assumption should not be made that all residents are incapable of becoming more involved in some aspects of their own care. A greater focus on resident-centred care may promote more empowerment and autonomy, both generally and with respect to compliance with medication in particular, in nursing home residents.
服药依从性一直被频繁提及，是社区环境中患者面临的一个问题。然而，对于养老院居民的服药依从性问题，却鲜有评论。这可能是因为人们认为居民会定期服药，且服药过程会受到监督，因此，依从性不被视为一个问题。然而，如果未对药物的适用性进行审查，那么定期依从性可能并不总是合适的，这种“强制”依从性可能会导致副作用或不良反应。由于工作人员给药时间不便，或者给药说明困难且耗时，居民也可能会面临“不规律”的依从性情况。这可能会对需要定期服药的居民产生临床影响，例如患有帕金森病的居民。强制或不规律的依从性与共同决策相悖，而共同决策正被倡导为一种赋予患者权力的方式。可能有人会认为，由于认知障碍程度较高，养老院居民不适合参与药物治疗的决策。然而，养老院人群在本质上是异质的，不应假定所有居民都无法更多地参与自身护理的某些方面。更加关注以居民为中心的护理可能会在总体上，特别是在服药依从性方面，促进养老院居民更多的赋权和自主性。
