Williams Allison, Manias Elizabeth
School of Nursing and Midwifery, Monash University Health Sciences, Frankston, Vic., Australia.
J Clin Nurs. 2014 Feb;23(3-4):471-81. doi: 10.1111/jocn.12171. Epub 2013 Sep 13.
To explore the motivation and confidence of people with coexisting diabetes, chronic kidney disease (CKD) and hypertension to take their medicines as prescribed.
These comorbidities are major contributors to disease burden globally. Self-management of individuals with these coexisting diseases is much more complicated than that of those with single diseases and is critical for improved health outcomes.
Motivational interviewing telephone calls were made with participants with coexisting diabetes, CKD and hypertension.
Patients aged ≥18 years with diabetes, CKD and systolic hypertension were recruited from outpatient clinics of an Australian metropolitan hospital between 2008-2009. An average of four motivational interviewing telephone calls was made with participants (n = 39) in the intervention arm of a randomised controlled trial. Data were thematically analysed using the modified Health Belief Model as a framework.
Participants' motivation and confidence in taking prescribed medicines was thwarted by complex medicine regimens and medical conditions. Participants wanted control over their health and developed various strategies to confront threats to health. The perceived barriers of taking recommended health action outweighed the benefits of taking medicines as prescribed and were primarily related to copious amounts of medicines.
Taking multiple prescribed medicines in coexisting diabetes, CKD and hypertension is a perpetual vocation with major psychosocial effects. Participants were overwhelmed by the number of medicines that they were required to take. The quest for personal control of health, fear of the future and the role of stress and gender in chronic disease management have been highlighted. Participants require supportive emotional interventions to self-manage their multiple medicines on a daily basis.
Reducing the complexity of medicine regimens in coexisting diseases is paramount. Individualised psychosocial approaches that address the emotional needs of patients with regular follow-up and feedback are necessary for optimal chronic disease self-management.
探讨同时患有糖尿病、慢性肾脏病（CKD）和高血压的患者按医嘱服药的动机和信心。
这些合并症是全球疾病负担的主要促成因素。患有这些并存疾病的个体的自我管理比单一疾病患者的自我管理复杂得多，对改善健康结果至关重要。
对同时患有糖尿病、CKD和高血压的参与者进行动机性访谈电话沟通。
2008年至2009年期间，从澳大利亚一家大都市医院的门诊招募年龄≥18岁、患有糖尿病、CKD和收缩期高血压的患者。对随机对照试验干预组的参与者（n = 39）平均进行了四次动机性访谈电话沟通。以改良的健康信念模型为框架对数据进行主题分析。
复杂的药物治疗方案和医疗状况阻碍了参与者按医嘱服药的动机和信心。参与者希望掌控自己的健康，并制定了各种策略来应对健康威胁。采取推荐的健康行动的感知障碍超过了按医嘱服药的益处，主要与大量药物有关。
同时患有糖尿病、CKD和高血压的患者服用多种处方药是一项长期任务，会产生重大的心理社会影响。参与者被要求服用的药物数量压得喘不过气来。对健康的个人掌控、对未来的恐惧以及压力和性别在慢性病管理中的作用已得到凸显。参与者需要支持性的情感干预来每天自我管理多种药物。
降低并存疾病药物治疗方案的复杂性至关重要。采用个性化的心理社会方法，满足患者的情感需求，定期随访并给予反馈，对于优化慢性病自我管理是必要的。
