Yoel Uri, Abu-Hammad Talab, Cohen Arnon, Aizenberg Alexander, Vardy Daniel, Shvartzman Pesach
Siaal Research Center for Family Medicine and Primary Care, Department of Family Medicine, Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
Isr Med Assoc J. 2013 Jan;15(1):17-22.
The rate of adherence to treatment for diabetes mellitus (DM), hypertension (HTN) and lipid metabolic disorder (LMD) is significantly lower in the Bedouin population compared with the lewish population in southern Israel.
To investigate the reasons for non-adherence associated with cardiovascular risk factors among Bedouins.
We identified Bedouin patients with HTN, DM or LMD from medical records and randomly selected 443 high adherent and 403 low adherent patients. Using trained interviewers we conducted in-depth structured interviews regarding knowledge and attitudes to chronic illness and its treatment, health services evaluation, and socio-demographic factors.
The study population included 99 high and 101 low adherent patients. More low adherent patients agreed that traditional therapy can replace prescribed medications for DM, HTN or LMD (47% vs. 26%, P< 0.01), and 10% used only traditional medications. Also, more low adherent patients believed that the side effects of prescribed drugs are actually worse than the disease itself (65% vs. 47%, P 0.05), and 47% cited this as a reason for discontinuing drug treatment (47% vs. 31%, P < 0.05).
Our findings suggest that in this minority population the basis for non-adherence derives directly from patients' perceptions of chronic disease and drug treatment. A focused intervention should emphasize the importance of early evidence-based drug therapy with open patient-physician dialogue on the meaning of chronic disease and the side effects of prescribed drugs.
与以色列南部的犹太人群体相比，贝都因人群体中糖尿病（DM）、高血压（HTN）和脂质代谢紊乱（LMD）的治疗依从率显著较低。
调查贝都因人中与心血管危险因素相关的不依从原因。
我们从医疗记录中识别出患有高血压、糖尿病或脂质代谢紊乱的贝都因患者，并随机选择443名高依从性患者和403名低依从性患者。通过训练有素的访谈者，我们就对慢性病及其治疗的知识和态度、卫生服务评估以及社会人口学因素进行了深入的结构化访谈。
研究人群包括99名高依从性患者和101名低依从性患者。更多低依从性患者认同传统疗法可以替代糖尿病、高血压或脂质代谢紊乱的处方药（47%对26%，P<0.01），且10%的患者仅使用传统药物。此外，更多低依从性患者认为处方药的副作用实际上比疾病本身更严重（65%对47%，P 0.05），47%的患者将此作为停药的原因（47%对31%，P<0.05）。
我们的研究结果表明，在这个少数群体中，不依从的根本原因直接源于患者对慢性病和药物治疗的认知。有针对性的干预应强调早期循证药物治疗的重要性，并就慢性病的意义和处方药的副作用开展开放的医患对话。
