Department of Medicine, Division of Preventive Medicine, the School of Public Health, Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294-4410, USA.
J Clin Hypertens (Greenwich). 2010 Sep;12(9):706-13. doi: 10.1111/j.1751-7176.2010.00321.x.
Control of hypertension remains poor, and lack of adherence to medication is considered a primary reason. Few studies have examined the reasons for medication nonadherence in African American, lower-income, rural adults receiving medications at no personal cost. Moreover, our understanding of how the provider-patient relationship influences adherence in this population is limited. In this study, the authors (1) examined reasons for taking less medication than prescribed and (2) examined the association between provider-patient variables and medication adherence. A total of 434 participants (94.8% African American) were included. The most frequently endorsed reasons for taking less medication than prescribed were not having blood pressure medicine when it was time to take a dose (36%), running out of medicine (35%), bothered by side effects (29%), and a change in one's daily routine (27%). Nonadherent individuals were significantly more likely to report discomfort with asking the health provider questions (74% vs 63%), were more likely to report that health care visits were stressful (25% vs 16%), and exhibited more depressive symptoms (58% vs 45%). Adherent patients had lower blood pressure (systolic: 133±15.8 mm Hg vs 138±17.6 mm Hg, P value=.002; diastolic: 80±9.8 mm Hg vs 83±11 mm Hg, P value=.003) than individuals who were less adherent. Clinicians providing care to rural, poor hypertensive patients should routinely assess self-management behaviors, logistical barriers, and emotional health. Creating clinical encounters that minimize the stressful nature of the visit and encourage patient question-asking behavior may also be important for the optimal management of hypertension.
高血压的控制仍然很差，而不遵医嘱被认为是主要原因之一。很少有研究调查过在不支付个人费用的情况下接受药物治疗的非裔美国人和低收入、农村成年人不遵医嘱的原因。此外，我们对提供者-患者关系如何影响该人群的依从性的理解也很有限。在这项研究中，作者（1）检查了服用少于规定剂量的药物的原因，（2）检查了提供者-患者变量与药物依从性之间的关联。共有 434 名参与者（94.8%为非裔美国人）被纳入研究。服用少于规定剂量的药物的最常见原因是（36%）当需要服药时没有血压药，（35%）药物用完了，（29%）药物副作用困扰，（27%）日常生活改变。不遵医嘱的人更有可能报告对向医疗保健提供者提问感到不适（74%比 63%），更有可能报告就诊压力大（25%比 16%），表现出更多的抑郁症状（58%比 45%）。依从性好的患者的血压（收缩压：133±15.8 毫米汞柱比 138±17.6 毫米汞柱，P 值=0.002；舒张压：80±9.8 毫米汞柱比 83±11 毫米汞柱，P 值=0.003）比不依从的患者低。为农村贫困高血压患者提供护理的临床医生应定期评估自我管理行为、实际障碍和情绪健康。创造尽可能减少就诊紧张性质并鼓励患者提问的临床环境，对于高血压的最佳管理也可能很重要。
