Decker Carole, Garavalia Linda, Garavalia Brian, Spertus John A
Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO, USA;
Patient Prefer Adherence. 2008 Feb 2;2:167-75. doi: 10.2147/ppa.s3443.
Each day, patients make choices whether or not to take their prescribed medications. Previous research has shown that 1 in 7 myocardial infarction (MI) patients discontinued thienopyridines within 1 month of receiving a drug-eluting stent (DES) with serious consequences. This qualitative research study explored in depth the clopidogrel-taking behavior among DES-treated patients who quit taking clopidogrel 1 month after treatment and those who continued therapy.
Sequential patients from a prospective MI registry who reported discontinuing clopidogrel within 30 days of DES treatment (N = 11) were matched with continuers (N = 11). Both groups underwent detailed qualitative phone interviews. Coding and thematic representation using directed qualitative content analysis by 3 PhD researchers was done.
Patients were 41-77 years old and the majority was Caucasian and male. Multiple barriers were described by discontinuers that were not reported by continuers. The most frequently cited barrier was misunderstanding the intended duration of treatment. Discontinuers also described system weaknesses that contributed to early discontinuance such as gaps in the transition to primary care.
While premature discontinuation of a prescribed therapy is viewed by clinicians as a willful disregard for medical advice, early stopping of clopidogrel is influenced greatly by processes of care and system issues.
患者每天都要做出是否服用处方药的选择。先前的研究表明，每7名心肌梗死（MI）患者中就有1人在接受药物洗脱支架（DES）治疗后1个月内停用噻吩吡啶类药物，这会带来严重后果。这项定性研究深入探讨了DES治疗患者中氯吡格雷的服用行为，这些患者在治疗1个月后停止服用氯吡格雷以及那些继续治疗的患者。
从一项前瞻性MI登记研究中选取在DES治疗后30天内报告停用氯吡格雷的连续患者（N = 11），与继续服用氯吡格雷的患者（N = 11）进行匹配。两组患者均接受了详细的定性电话访谈。由3名博士研究人员采用定向定性内容分析法进行编码和主题呈现。
患者年龄在41 - 77岁之间，大多数为白种人男性。停药患者描述了多种继续用药患者未提及的障碍。最常提及的障碍是对预期治疗时长的误解。停药患者还描述了导致早期停药的系统缺陷，如向初级医疗过渡过程中的脱节。
虽然临床医生认为过早停用规定疗法是故意无视医疗建议，但氯吡格雷的早期停药在很大程度上受医疗过程和系统问题的影响。
