Gordon Elisa J, Gallant Mary, Sehgal Ashwini R, Conti David, Siminoff Laura A
Institute for Healthcare Studies, Department of Surgery, Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Transpl Int. 2009 May;22(5):534-45. doi: 10.1111/j.1432-2277.2008.00827.x. Epub 2009 Jan 16.
Medication adherence is essential for the survival of kidney grafts, however, the complexity of the medication-taking regimen makes adherence difficult. Little is known about barriers to medication-taking and strategies to foster medication-taking. This cross-sectional study involved semi-structured interviews with 82 kidney transplant recipients approximately 2 months post-transplant on medication-related adherence, barriers to medication-taking, and strategies to foster medication-taking. Although self-reported adherence was high (88%), qualitative analysis revealed that half of the patients (49%) reported experiencing at least one barrier to medication-taking. The most common barriers were: not remembering to refill prescriptions (13%), changes to medication prescriptions or dosages (13%), being busy (10%), forgetting to bring medicines with them (10%), and being away from home (10%). The most common strategies to foster medication-taking were: maintaining a schedule of medication-taking (60%), organizing pills using pillboxes, baggies, cups (42%), bringing medicines with them (34%), organizing pills according to routine times (32%), and relying on other people to remind them (26%). Understanding the range of barriers to adherence and strategies kidney recipients devised to promote medication-taking may help transplant clinicians to better educate transplant recipients about appropriate medication-taking, mitigate the risk of medication nonadherence-related rejection, and may help inform patient-centered interventions to improve medication adherence.
药物依从性对于肾移植的存活至关重要,然而,服药方案的复杂性使得依从性难以实现。对于服药的障碍和促进服药的策略知之甚少。这项横断面研究包括对82名肾移植受者进行半结构化访谈,这些受者在移植后约2个月时就药物相关依从性、服药障碍和促进服药的策略进行访谈。尽管自我报告的依从性很高(88%),但定性分析显示,一半的患者(49%)报告至少经历过一种服药障碍。最常见的障碍是:忘记重新开处方(13%)、药物处方或剂量的改变(13%)、忙碌(10%)、忘记随身携带药物(10%)以及离家在外(10%)。促进服药的最常见策略是:维持服药时间表(60%)、使用药盒、袋子、杯子整理药片(42%)、随身携带药物(34%)、按照常规时间整理药片(32%)以及依靠他人提醒(26%)。了解依从性障碍的范围以及肾移植受者为促进服药而设计的策略,可能有助于移植临床医生更好地对移植受者进行适当服药的教育,降低与药物不依从相关的排斥风险,并且可能有助于为以患者为中心的干预措施提供信息以提高药物依从性。