Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, USA.
J Am Geriatr Soc. 2012 Jun;60(6):1019-26. doi: 10.1111/j.1532-5415.2012.03969.x. Epub 2012 May 30.
To investigate provider opinions about responsibility for medication adherence and examine physician-patient interactions to illustrate how adherence discussions are initiated.
Focus group discussions with healthcare providers and audio taped outpatient office visits with a separate group of providers.
Focus group participants were recruited from multispecialty practice groups in New Jersey and Washington, District of Columbia. Outpatient office visits were conducted in primary care offices in Northern California.
Twenty-two healthcare providers participated in focus group discussions. One hundred patients aged 65 and older and 28 primary care physicians had their visits audio taped.
Inductive content analysis of focus groups and audio taped encounters.
Focus group analyses indicated that providers feel responsible for assessing medication adherence during office visits and for addressing mutable factors underlying nonadherence, but they also believed that patients were ultimately responsible for taking medications and voiced reluctance about confronting patients about nonadherence. The 100 patients participating in audio taped encounters were taking a total of 410 medications. Of these, 254 (62%) were discussed in a way that might address adherence; physicians made simple inquiries about current patient medication use for 31.5%, but they made in-depth inquiries about adherence for only 4.3%. Of 39 identified instances of nonadherence, patients spontaneously disclosed 51%.
The lack of intrusive questions about medication taking during office visits may reflect poor provider recognition of the questions needed to assess adherence fully. Alternatively, provider beliefs about patient responsibility for adherence may hinder detailed queries. A paradigm of joint provider-patient responsibility may be needed to better guide discussions about medication adherence.
调查提供者对药物依从性责任的看法，并考察医患互动，以说明如何开始进行依从性讨论。
对医疗保健提供者进行焦点小组讨论，并对另一组提供者进行单独的门诊就诊录音。
焦点小组参与者是从新泽西州和华盛顿特区的多专业实践小组招募的。门诊就诊是在加利福尼亚州北部的基层医疗办公室进行的。
22 名医疗保健提供者参加了焦点小组讨论。100 名 65 岁及以上的患者和 28 名初级保健医生的就诊被录音。
对焦点小组和录音访谈进行归纳内容分析。
焦点小组分析表明，提供者认为在就诊期间评估药物依从性并解决导致不依从的可改变因素是他们的责任，但他们也认为患者最终负责服药，并表示不愿与患者讨论不依从问题。100 名参加录音访谈的患者共服用 410 种药物。其中，254 种（62%）以可能解决依从性问题的方式进行了讨论；医生对当前患者用药情况进行了简单询问，占 31.5%，但仅对 4.3%进行了深入询问。在 39 例确定的不依从事件中，患者自发披露了 51%。
在就诊期间对服药情况缺乏深入询问可能反映了提供者对评估依从性所需问题的识别不足。或者，提供者对患者对依从性责任的信念可能会阻碍详细查询。可能需要一种提供者-患者共同责任的范例来更好地指导关于药物依从性的讨论。
