药物疗效可能不是接受心血管预防药物治疗的主要原因：一项基于人群的调查。
Medication effectiveness may not be the major reason for accepting cardiovascular preventive medication: a population-based survey.
机构信息
Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
出版信息
BMC Med Inform Decis Mak. 2012 Aug 9;12:89. doi: 10.1186/1472-6947-12-89.
BACKGROUND
Shared decision-making and patients' choice of interventions are areas of increasing importance, not least seen in the light of the fact that chronic conditions are increasing, interventions considered important for public health, and still non-acceptance of especially risk-reducing treatments of cardiovascular diseases (CVD) is prevalent. A better understanding of patients' medication-taking behavior is needed and may be reached by studying the reasons why people accept or decline medication recommendations. The aim of this paper was to identify factors that may influence people's decisions and reasoning for accepting or declining a cardiovascular preventive medication offer.
METHODS
From a random sample of 4,000 people aged 40-59 years in a Danish population, 1,169 participants were asked to imagine being at increased risk of cardiovascular disease and being offered a preventive medication. After receiving 'complete' information about effectiveness of the medication they were asked whether they would accept medication. Finally, they were asked about reasons for the decision.
RESULTS
A total of 725 (67%) of 1,082 participants accepted the medication offer. Even quite large effects of medication (up to 8 percentage points absolute risk reduction) had a smaller impact on acceptance to medication than personal experience with cardiovascular disease. Furthermore, increasing age of the participant and living with a partner were significantly associated with acceptance. Some 45% of the respondents accepting justified their choice as being for health reasons, and they were more likely to be women, live alone, have higher income and higher education levels. Among those who did not accept the medication offer, 56% indicated that they would rather prefer to change lifestyle.
CONCLUSIONS
Medication effectiveness seems to have a moderate influence on people's decisions to accept preventive medication, while factors such as personal experience with cardiovascular disease may have an equally strong or stronger influence, indicating that practitioners could do well to carefully identify the reasons for their patients' treatment decisions.
背景
共同决策和患者对干预措施的选择是日益重要的领域，尤其是在慢性病不断增加、干预措施被认为对公共卫生很重要且人们对心血管疾病（CVD）风险降低治疗的接受度仍然较低的情况下。需要更好地了解患者的用药行为，这可以通过研究人们接受或拒绝药物建议的原因来实现。本文的目的是确定可能影响人们接受或拒绝心血管预防药物建议的决策和推理的因素。
方法
从丹麦人群中随机抽取的 4000 名 40-59 岁的人群中，有 1169 人被要求想象自己患有心血管疾病风险增加，并被提供预防药物。在收到有关药物有效性的“完整”信息后，他们被问及是否会接受药物治疗。最后，他们被问及做出决定的原因。
结果
在 1082 名参与者中，共有 725 名（67%）接受了药物治疗。即使药物的效果相当大（高达 8 个百分点的绝对风险降低），也比个人心血管疾病经历对接受药物治疗的影响要小。此外，参与者年龄的增加和与伴侣生活在一起与接受治疗显著相关。约 45%接受药物治疗的受访者认为他们的选择是出于健康原因，他们更有可能是女性、独居、收入较高和教育程度较高。在那些不接受药物治疗的受访者中，56%的人表示他们更愿意改变生活方式。
结论
药物的有效性似乎对人们接受预防药物的决定有中等影响，而个人心血管疾病经历等因素可能具有同样强烈或更强的影响，这表明医生可以很好地仔细识别患者治疗决策的原因。
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