Mann Devin M
Mount Sinai School of Medicine, New York, New York, USA.
Geriatrics. 2009 Sep;64(9):10-5.
When faced with difficult-to-control cardiovascular risk factors, clinicians need to address the potential role of patient adherence to medication. Among the elderly in particular, careful consideration must be paid to accurately diagnosing an adherence problem in the context of often worsening atherosclerosis. This process includes moving beyond relying on clinical intuition to ascertain whether a patient has "real" (e.g., identifiable) reasons for suboptimal risk factor control and becoming comfortable using evidence-based questions and other ancillary data, when available, to more objectively identify patients with adherence issues. Once identified, a tailored search for an etiology that explores elderly specific patient, physician, and health care system factors needs to be conducted to understand why adherence is a problem for the patient. Finally, clinicians should employ simple tools and clear communication to work with patients and to help them overcome the relevant barriers.
面对难以控制的心血管危险因素时，临床医生需要关注患者药物依从性的潜在作用。尤其是在老年人中，在动脉粥样硬化往往不断恶化的情况下，必须谨慎考虑以准确诊断依从性问题。这个过程包括不再仅仅依靠临床直觉来确定患者是否有“真正的”（例如，可识别的）危险因素控制不佳的原因，而是在有可用的循证问题和其他辅助数据时，能够自如地使用它们，以便更客观地识别存在依从性问题的患者。一旦识别出来，就需要针对性地寻找病因，探讨老年患者、医生和医疗系统等特定因素，以了解为什么依从性对患者来说是个问题。最后，临床医生应使用简单的工具并进行清晰的沟通，与患者合作，帮助他们克服相关障碍。
