Ekman Inger, Wolf Axel, Vaughan Dickson Victoria, Bosworth Hayden B, Granger Bradi B
1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
2 Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
Eur J Cardiovasc Nurs. 2017 Oct;16(7):646-654. doi: 10.1177/1474515117707669. Epub 2017 May 12.
Ineffective medication management contributes to repeated hospitalisation and death among patients with heart failure. The meaning ascribed to medications and the influence of meaning on how patients manage medications is unknown. The purpose of this study was to explore the meaning and expectations associated with medication use in high-risk, non-adherent patients with heart failure.
Patients ( n=265) with heart failure were screened for adherence to prescribed medication using the Morisky medication adherence scale (MMAS). Patients (MMAS score <6; n=44) participated in semistructured interviews, analysed using qualitative content analysis. Of 17 initial themes (223 representative segments), the overarching theme 'unmet expectations' consisted of two subthemes 'working to be heard' by professionals and 'resignation' to both the illness and medications. Patients' expectations were challenged by unexpected work to communicate with providers in general (72 representative segments), and specifically regarding medications (118 representative segments) and feelings of resignation regarding the medication regimen (33 representative segments).
These findings suggest that unmet expectations contribute to poor medication management. Improved listening and communication by providers, to establish a common understanding and plan for managing medications may strengthen patient beliefs, resolve feelings of resignation and improve patients' ability to manage medications effectively.
药物管理不善会导致心力衰竭患者反复住院和死亡。药物的意义以及意义对患者药物管理方式的影响尚不清楚。本研究的目的是探讨高危、不依从的心力衰竭患者与药物使用相关的意义和期望。
使用莫利斯基药物依从性量表（MMAS）对心力衰竭患者（n = 265）进行药物依从性筛查。患者（MMAS评分<6；n = 44）参与了半结构化访谈，并采用定性内容分析法进行分析。在17个初始主题（223个代表性片段）中，总体主题“未满足的期望”由两个子主题组成，即希望被专业人员“倾听”以及对疾病和药物的“顺从”。患者的期望受到与医疗服务提供者沟通方面意外情况的挑战（72个代表性片段），特别是在药物方面（118个代表性片段）以及对药物治疗方案的顺从感（33个代表性片段）。
这些发现表明，未满足的期望会导致药物管理不善。医疗服务提供者改善倾听和沟通，以建立对药物管理的共同理解和计划，可能会增强患者的信念，消除顺从感，并提高患者有效管理药物的能力。
