Ho Siew Ching, Jacob Sabrina Anne, Tangiisuran Balamurugan
School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.
PLoS One. 2017 Jun 14;12(6):e0179290. doi: 10.1371/journal.pone.0179290. eCollection 2017.
One of the major challenges in treating major depressive disorder (MDD) is patients' non-adherence to medication. This study aimed to explore the barriers and facilitators of patients' adherence to antidepressants among outpatients with MDD.
Semi-structured and individual in-depth interviews were conducted among patients with MDD who were taking antidepressants, in the psychiatric clinic of a government-run hospital in Malaysia. Participants were purposively sampled from different genders and ethnicities. Interviews were conducted using a validated topic guide, and responses were audio-recorded, transcribed verbatim, checked, and analyzed using the grounded theory approach.
A total of 30 patients were interviewed. Forty different themes and sub-themes were identified which were conceptually divided into two distinct categories related to barriers and facilitators to adherence. The barriers were: patient-specific, medication-specific, healthcare provision and system, social-cultural, and logistics. The facilitators were: having insight, perceived health benefits, regular activities, patient-provider relationship, reminders, and social support networks.
Patient-specific barriers and medication side effects were the major challenges for adhering to treatment. Perceived health benefits and having insight on the need for treatment were the most frequently cited facilitators. Targeted interventions should be developed to address the key barriers, and promote measures to facilitate adherence in this group of patients.
治疗重度抑郁症（MDD）的主要挑战之一是患者不坚持服药。本研究旨在探讨MDD门诊患者坚持服用抗抑郁药的障碍和促进因素。
在马来西亚一家政府医院的精神科诊所，对正在服用抗抑郁药的MDD患者进行了半结构化的个人深度访谈。参与者按性别和种族进行目的抽样。访谈使用经过验证的主题指南进行，回答内容进行了录音、逐字转录、核对，并采用扎根理论方法进行分析。
共访谈了30名患者。确定了40个不同的主题和子主题，从概念上分为与坚持服药的障碍和促进因素相关的两个不同类别。障碍包括：患者特定因素、药物特定因素、医疗服务提供与系统、社会文化因素和后勤因素。促进因素包括：有洞察力、感知到健康益处、规律活动、医患关系、提醒和社会支持网络。
患者特定障碍和药物副作用是坚持治疗的主要挑战。感知到健康益处和对治疗需求有洞察力是最常被提及的促进因素。应制定有针对性的干预措施来解决关键障碍，并推广促进该组患者坚持服药的措施。
