沟通可预测青光眼患者的药物自我效能感。
Communication Predicts Medication Self-Efficacy in Glaucoma Patients.
作者信息
Carpenter Delesha M, Blalock Susan J, Sayner Robyn, Muir Kelly W, Robin Alan L, Hartnett Mary Elizabeth, Giangiacomo Annette L, Tudor Gail E, Sleath Betsy L
机构信息
*PhD, MSPH †PhD, MPH ‡PharmD §MD ∥PhD Division of Pharmaceutical Outcomes and Policy (DMC), University of North Carolina at Chapel Hill, Asheville Satellite Campus, Asheville, North Carolina; Division of Pharmaceutical Outcomes and Policy (SJB, BLS), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Medicine (RS), Stanford University, Stanford, California; Duke University School of Medicine & Durham VA Medical Center (KWM), Durham, North Carolina; Wilmer Institute and Bloomberg School of Public Health (ALR), Johns Hopkins University, Baltimore, Maryland; Department of Ophthalmology (ALR), University of Maryland, College Park, Maryland; John A. Moran Eye Center (MEH), University of Utah, Salt Lake City, Utah; School of Medicine (ALG), Emory University, Atlanta, Georgia; and Department of Mathematics and Statistics (GET), Husson University, Bangor, Maine.
出版信息
Optom Vis Sci. 2016 Jul;93(7):731-7. doi: 10.1097/OPX.0000000000000856.
PURPOSE
Medication self-efficacy, or patients' confidence that they can perform medication-related behaviors, is associated with better glaucoma medication adherence. Little is known about how to enhance glaucoma patients' medication self-efficacy. Our purpose is to examine whether patient-provider communication increases glaucoma patients' medication self-efficacy.
METHODS
During an 8-month cohort study of 279 glaucoma patients and 15 providers, two office visits were videotape-recorded, transcribed, and coded for six patient-provider communication behaviors. A validated scale was used at baseline and 8-month follow-up to assess patients' confidence in overcoming adherence barriers (adherence barriers self-efficacy) and carrying out tasks to use eye drops correctly (eye drop task self-efficacy). We ran two generalized estimating equations to examine whether more frequent patient-provider communication during office visits predicted increased patient adherence barriers self-efficacy and eye drop task self-efficacy at 8-month follow-up.
RESULTS
For each additional topic providers educated about, patients reported an average increase of 0.35 in self-efficacy in overcoming adherence barriers (p < 0.001). Patients also reported an average increase of 1.01 points in eye drop task self-efficacy when providers asked about patients' views of glaucoma and its treatment versus not (p < 0.001). Patients who asked more medication questions (p < 0.001) and African-American patients (p < 0.05) reported lower adherence barriers self-efficacy by 0.30 and 2.15 points, respectively. Women had a 0.63 lower eye drop task self-efficacy than men (p < 0.05).
CONCLUSIONS
When providers educate glaucoma patients and assess patient views about glaucoma and its treatment, patients report higher medication self-efficacy. Providers should be aware that patients who ask more medication questions may have less confidence in their ability to overcome barriers to adherence.
目的
药物自我效能，即患者对自身能够执行与药物相关行为的信心，与更好的青光眼药物依从性相关。关于如何提高青光眼患者的药物自我效能知之甚少。我们的目的是研究患者与医疗服务提供者之间的沟通是否会提高青光眼患者的药物自我效能。
方法
在一项针对279名青光眼患者和15名医疗服务提供者的为期8个月的队列研究中，对两次门诊就诊进行录像、转录，并对六种患者与医疗服务提供者的沟通行为进行编码。在基线和8个月随访时使用经过验证的量表来评估患者克服依从性障碍的信心（依从性障碍自我效能）以及正确使用眼药水执行任务的信心（眼药水任务自我效能）。我们运行了两个广义估计方程，以研究门诊就诊期间更频繁的患者与医疗服务提供者沟通是否能预测8个月随访时患者依从性障碍自我效能和眼药水任务自我效能的提高。
结果
对于医疗服务提供者讲解的每个额外主题，患者报告克服依从性障碍的自我效能平均提高0.35（p < 0.001）。当医疗服务提供者询问患者对青光眼及其治疗的看法时，患者报告眼药水任务自我效能平均提高1.01分，而未询问时则不然（p < 0.001）。询问更多药物问题的患者（p < 0.001）和非裔美国患者（p < 0.05）报告的依从性障碍自我效能分别低0.30分和2.15分。女性的眼药水任务自我效能比男性低0.63（p < 0.05）。
结论
当医疗服务提供者对青光眼患者进行教育并评估患者对青光眼及其治疗的看法时，患者报告的药物自我效能更高。医疗服务提供者应意识到，询问更多药物问题的患者对自己克服依从性障碍的能力可能信心较低。
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