老年多病共存患者对处方药的认知：一项初级保健中的混合方法研究
Beliefs about prescribed medication among older patients with polypharmacy: a mixed methods study in primary care.
作者信息
Clyne Barbara, Cooper Janine A, Boland Fiona, Hughes Carmel M, Fahey Tom, Smith Susan M
机构信息
HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin.
School of Pharmacy, Queen's University Belfast, Belfast.
出版信息
Br J Gen Pract. 2017 Jul;67(660):e507-e518. doi: 10.3399/bjgp17X691073. Epub 2017 May 22.
BACKGROUND
Polypharmacy (≥5 medications) is common in older patients and is associated with adverse outcomes. Patients' beliefs about medication can influence their expectations for medication, adherence, and willingness to deprescribe. Few studies have examined beliefs about prescribed medication among older patients with polypharmacy in primary care.
AIM
To explore medication-related beliefs in older patients with polypharmacy and factors that might influence beliefs.
DESIGN AND SETTING
A mixed methods study utilising data from a randomised controlled trial aiming to decrease potentially inappropriate prescribing in older patients (≥70 years) in Ireland.
METHOD
Beliefs were assessed quantitatively and qualitatively. Participants completed the Beliefs about Medicines Questionnaire by indicating their degree of agreement with individual statements about medicines on a 5-point Likert scale. Semi-structured qualitative interviews were conducted with a purposive sample of participants. Interviews were transcribed verbatim and a thematic analysis conducted. Quantitative and qualitative data were analysed separately and triangulated during the interpretation stage.
RESULTS
In total, 196 patients were included (mean age 76.7 years, SD 4.9, 54% male), with a mean of 9.5 (SD 4.1) medications per patient. The majority (96.3%) believed strongly in the necessity of their medication, while 33.9% reported strong concerns. Qualitative data confirmed these coexisting positive and negative attitudes to medications and suggested the importance of patients' trust in GPs in establishing positive beliefs and potential willingness to deprescribe.
CONCLUSION
Participants reported strong beliefs in medications with coexisting positive and negative attitudes. The doctor-patient relationship may have influenced beliefs and attitudes towards medicines, highlighting the importance of strong doctor-patient relationships, which need to be considered in the context of deprescribing.
背景
多重用药（≥5种药物）在老年患者中很常见，且与不良后果相关。患者对药物的信念会影响他们对药物的期望、依从性以及减药意愿。很少有研究调查基层医疗中患有多重用药问题的老年患者对处方药的信念。
目的
探讨患有多重用药问题的老年患者与药物相关的信念以及可能影响这些信念的因素。
设计与背景
一项混合方法研究，利用一项随机对照试验的数据，该试验旨在减少爱尔兰老年患者（≥70岁）潜在的不适当用药情况。
方法
对信念进行定量和定性评估。参与者通过在5点李克特量表上表明他们对关于药物的各个陈述的同意程度来完成《药物信念问卷》。对有目的抽取的参与者样本进行半结构化定性访谈。访谈逐字转录并进行主题分析。定量和定性数据分别进行分析，并在解释阶段进行三角互证。
结果
总共纳入了196名患者（平均年龄76.7岁，标准差4.9，54%为男性），每位患者平均服用9.5种（标准差4.1）药物。大多数（96.3%）患者坚信自己用药的必要性，而33.9%的患者表示有强烈担忧。定性数据证实了对药物并存的积极和消极态度，并表明患者对全科医生的信任在建立积极信念和潜在减药意愿方面的重要性。
结论
参与者报告了对药物的强烈信念，同时存在积极和消极态度。医患关系可能影响了对药物的信念和态度，突出了良好医患关系的重要性，在减药背景下需要考虑这一点。
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