Delucchi A, Gutierrez H, Arrellano P, Slater C, Meneses M, López I
Calvo Mackenna Children's Hospital, Medical Health Education Department, University of Chile, Santiago, Chile.
Transplant Proc. 2008 Nov;40(9):3241-3. doi: 10.1016/j.transproceed.2008.03.125. Epub 2008 Jul 21.
Kidney transplant is the best treatment for patients with chronic renal failure. Scientific advances have optimized immunosuppressive treatment; however, adherence to medical treatment is not always achieved. Our aims were to identify the key factors that influenced nonadherence behavior to define effective educational strategies. A qualitative study was performed through an analysis of patient/tutor questions in interviews. A quantitative analysis was applied to epidemiologic variables, time posttransplant, and percentages/frequencies of responses from the interviews. A transplant nurse, psychologist, and social worker elaborated an instrument based on seven questions related to the transplant, the risk and/or loss of the graft, events that happened as consequence of this fact, allowing interviewees to freely express their opinions. The interviews were recorded on a microcassette recorder for later transcription. The analysis was determined by categories containing the answers to each question according to frequency. Informed consent was obtained from the parent/tutor. Among 150 transplants performed from 1989 to 2006 there were 15 nonadherences among 80% interviewed subjects. The mean age was 9.7 years. Loss of the graft occurred in 50%, at 37.7 months, post-transplant from 67% deceased and 33% living donors with 25% of cases preemptive transplants. The main factors for nonadherence were lack of supervision in taking medications, numbers and fastidious schedules, family conflicts, and poor communication between parents and the medical team. In conclusion, it is necessary to modify the pattern for transplant patient care that allows the patient and family to actively participate in the medical process including a multidisciplinary group.
肾移植是慢性肾衰竭患者的最佳治疗方法。科学进步优化了免疫抑制治疗；然而，患者并非总能坚持药物治疗。我们的目的是确定影响不依从行为的关键因素，以制定有效的教育策略。通过分析访谈中患者/监护人的问题进行了一项定性研究。对流行病学变量、移植后时间以及访谈回复的百分比/频率进行了定量分析。一名移植护士、心理学家和社会工作者根据与移植、移植物风险和/或丢失、由此导致的事件相关的七个问题精心设计了一份调查问卷，使受访者能够自由表达意见。访谈用微型盒式录音机录制，以便后续转录。分析按每个问题答案的频率分类进行。已获得家长/监护人的知情同意。在1989年至2006年进行的150例移植手术中，80%的受访对象中有15例出现不依从情况。平均年龄为9.7岁。50%的患者在移植后37.7个月出现移植物丢失，其中67%的供体为已故者，33%为活体供体，25%的病例为抢先移植。不依从的主要因素包括服药时缺乏监督、药物数量和繁琐的服药时间表、家庭冲突以及家长与医疗团队之间沟通不畅。总之，有必要改变移植患者的护理模式，让患者及其家人能够积极参与包括多学科团队在内的医疗过程。
