Polis Suzanne, Zang Ling, Mainali Bhawana, Pons Rachel, Pavendranathan Gokulan, Zekry Amany, Fernandez Ritin
Centre for Research in Nursing and Health, Kogarah, New South Wales, Australia.
The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia.
J Clin Nurs. 2016 Jan;25(1-2):204-12. doi: 10.1111/jocn.13083.
Medication adherence in people with cirrhosis is largely unknown. This study aims to determine adherence patterns and factors associated with adherence in patients with cirrhosis.
Prescribed medications are a pivotal component in the clinical management of cirrhosis with potential to retard disease progression and reduce complication risks. Medication adherence is necessary to optimise health outcomes. Understanding why medications are missed may help to develop strategies and inform nursing practice.
Prospective cohort study.
Participants (n = 29) diagnosed with cirrhosis attending a tertiary hospital consented to complete a self-reported survey. Demographic information, adherence to medications, patient knowledge and quality of life data were collected, collated, checked and analysed using SPSS version 21.
Less than half of the 28 patients who completed the adherence questionnaire (n = 13, 46%) reported that they had never missed medication. Being forgetful, being away from home and falling asleep contributed to nonadherence. Having less abdominal symptoms, less fatigue and increased emotional well-being were significantly associated with patients never missing medications.
To our knowledge this is the first published study to describe adherent behaviour and the reasons medications are missed in this population. The percentage of nonadherent participants is of concern considering the potential morbidity risk that is associated with missed medications and rebound symptoms of cirrhosis. Strategies to improve and sustain adherence levels are required including enhanced adherence counselling offered to patients who are deteriorating or experience periodic exacerbation of symptoms.
Study findings have the potential to change clinical practice especially the way nurses target motivational adherence counselling, key treatment messages, education and adherence monitoring. The results presented here provide a basis for developing adherence strategies and nursing management plans to improve adherence and health outcomes in people with cirrhosis.
肝硬化患者的药物依从性情况在很大程度上尚不明确。本研究旨在确定肝硬化患者的依从模式以及与依从性相关的因素。
处方药物是肝硬化临床管理的关键组成部分，有可能延缓疾病进展并降低并发症风险。药物依从性对于优化健康结局至关重要。了解药物漏服的原因可能有助于制定策略并为护理实践提供依据。
前瞻性队列研究。
在一家三级医院就诊的29名被诊断为肝硬化的参与者同意完成一份自我报告调查。收集人口统计学信息、药物依从性、患者知识和生活质量数据，使用SPSS 21版进行整理、核对和分析。
在完成依从性问卷的28名患者中，不到一半（n = 13，46%）报告称他们从未漏服过药物。健忘、离家外出和入睡是导致不依从的原因。腹部症状较少、疲劳感较轻以及情绪状态改善与患者从未漏服药物显著相关。
据我们所知，这是首项发表的描述该人群依从行为及药物漏服原因的研究。考虑到漏服药物相关的潜在发病风险以及肝硬化的反弹症状，不依从参与者的比例令人担忧。需要制定提高和维持依从水平的策略，包括为病情恶化或症状周期性加重的患者提供强化的依从性咨询。
研究结果有可能改变临床实践，尤其是护士进行动机性依从性咨询、传达关键治疗信息、开展教育和进行依从性监测的方式。此处呈现的结果为制定依从性策略和护理管理计划提供了基础，以提高肝硬化患者的依从性和健康结局。
