Sarradon-Eck Aline, Egrot Marc, Blance Marie Anne, Faure Muriella
Anthropologist, Centre de recherche cultures, santé, sociétés (CReCSS), Université Paul Cézanne, Aix-Marseille, France.
Healthc Policy. 2010 May;5(4):e157-75.
Uncontrolled high blood pressure leads clinicians to wonder about adherence degree among hypertensive patients. In this context, our study aims to describe and analyze patients' experience of antihypertensive drugs in order to shed light on the multiple social and symbolic logics, forming part of the cultural factors shaping personal medication practices.
The medical inductive and comprehensive anthropological approach implemented is based on an ethnographic survey (observations of consultations and interviews). Semi-structured interviews were conducted with 68 hypertensive patients (39 women and 29 men, between the ages of 40 and 95, of whom 52 were over 60) who had been receiving treatment for over a year.
Antihypertensive drugs are reinterpreted when filtered through the cultural model of physiopathology (the body as an engine). This symbolic dimension facilitates acceptance of therapy but leads to a hierarchization of other prescribed drugs and of certain therapeutic classes (diuretics). Prescription compliance does not solely depend on the patient's perception of cardiovascular risk, but also on how the patient fully accepts the treatment and integrates it into his or her daily life; this requires identification with the product, building commitment and self-regulation of the treatment (experience, managing treatment and control of side effects, intake and treatment continuity). Following the prescription requires a relationship based on trust between the doctor and patient, which we have identified in three forms: reasoned trust, emotional trust and conceded trust.
Consideration and understanding of these pragmatic and symbolic issues by the treating physician should aid practitioners in carrying out their role as medical educators in the management of hypertension. This paper was originally published in French, in the journal Pratiques et organisation des soins 39(1): 3-12.
血压控制不佳会让临床医生对高血压患者的依从程度产生疑问。在此背景下，我们的研究旨在描述和分析患者对抗高血压药物的体验，以揭示构成塑造个人用药习惯的文化因素一部分的多种社会和象征逻辑。
所采用的医学归纳法和全面的人类学方法基于人种学调查（会诊观察和访谈）。对68名接受治疗超过一年的高血压患者（39名女性和29名男性，年龄在40至95岁之间，其中52名年龄超过60岁）进行了半结构化访谈。
当通过病理生理学的文化模型（身体如发动机）进行过滤时，抗高血压药物会被重新诠释。这种象征维度有助于治疗的接受，但会导致其他处方药和某些治疗类别（利尿剂）的等级化。处方依从性不仅取决于患者对心血管风险的认知，还取决于患者对治疗的完全接受程度以及将其融入日常生活的方式；这需要认同产品、建立对治疗的承诺和自我调节（经验、管理治疗和控制副作用、服药和治疗连续性）。遵循处方需要医生和患者之间基于信任的关系，我们已识别出三种形式：理性信任、情感信任和让步信任。
治疗医生对这些务实和象征问题的考虑与理解应有助于从业者在高血压管理中发挥医学教育者的作用。本文最初以法语发表于《Pratiques et organisation des soins》39(1): 3 - 12期刊。
