Kobue Boitshoko, Moch Shirra, Watermeyer Jennifer
Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2050, South Africa.
Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, and Centre for Health Science Education, Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2050, South Africa.
BMC Health Serv Res. 2017 Apr 26;17(1):303. doi: 10.1186/s12913-017-2246-8.
Patients with chronic illnesses are often required to take lifelong medication to alleviate symptoms and prevent disease progression. Many patients find it difficult to adhere to prescribed medication for various reasons, some of which may link to the way they conceptualise medicines and understand their illness and treatment. This study explores the medicine taking behaviours of patients presenting with Rheumatoid Arthritis (RA), a chronic inflammatory autoimmune disease. We focused particularly on patients' conceptualisation and understanding of medicines within this disease context, against a backdrop of scarce healthcare resources.
We conducted semi-structured interviews with 18 female patients at a rheumatology clinic in South Africa, as well as a review of participants' medical records. We conducted a secondary analysis of the data using thematic analysis and framework analysis principles.
Participants reported a range of medicine taking behaviours including self-medicating, adding complementary and alternative medicines (CAM) or traditional remedies, and sometimes acquiring prescribed medicines illegally. Participants provided insights into their understanding of what constitutes a medicine and what substances can be added to a prescribed regimen, which impacted on adherence. Importantly, the majority of participants demonstrated poor understanding of their illness, medications, regimens and dosage instructions.
Medicine taking in the context of RA, within the studied demographic, is complex and appears strongly mediated by individual and contextual factors. Poor patient understanding, individual conceptualisation of medicines and medicine taking, and the availability of a range of additional medicines and remedies impact on adherence. Based on these findings, we make some suggestions for how healthcare providers can play a greater role in educating patients living with RA about medicines, CAM and traditional remedies, as well as medicine taking behaviours.
慢性病患者常常需要终身服药以缓解症状并预防疾病进展。许多患者由于各种原因难以坚持按医嘱服药，其中一些原因可能与他们对药物的认知方式以及对自身疾病和治疗的理解有关。本研究探讨了类风湿关节炎（RA）患者的服药行为，RA是一种慢性炎症性自身免疫疾病。在医疗资源稀缺的背景下，我们特别关注了患者在这种疾病背景下对药物的认知和理解。
我们在南非的一家风湿病诊所对18名女性患者进行了半结构化访谈，并查阅了参与者的病历。我们运用主题分析和框架分析原则对数据进行了二次分析。
参与者报告了一系列服药行为，包括自我用药、添加补充和替代药物（CAM）或传统疗法，有时还会非法获取处方药。参与者阐述了他们对什么构成药物以及哪些物质可以添加到处方用药方案中的理解，这对服药依从性产生了影响。重要的是，大多数参与者对自身疾病、药物、用药方案和剂量说明的理解较差。
在所研究的人群中，类风湿关节炎患者的服药情况很复杂，并且似乎受到个体和环境因素的强烈影响。患者理解不足、对药物和服药的个体认知，以及一系列额外药物和疗法的可得性都会影响服药依从性。基于这些发现，我们就医疗服务提供者如何在向类风湿关节炎患者传授有关药物、补充和替代药物及传统疗法以及服药行为方面发挥更大作用提出了一些建议。
