Jamison James, Sutton Stephen, Mant Jonathan, De Simoni Anna
Primary Care Unit, Department of Public Health and Primary Care, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
BMJ Open. 2017 Jul 16;7(7):e016814. doi: 10.1136/bmjopen-2017-016814.
To identify barriers and facilitators of medication adherence in patients with stroke along with their caregivers.
Qualitative thematic analysis of posts about secondary prevention medications, informed by Perceptions and Practicalities Approach.
Posts written by the UK stroke survivors and their family members taking part in the online forum of the Stroke Association, between 2004 and 2011.
84 participants: 49 stroke survivors, 33 caregivers, 2 not stated, identified using the keywords 'taking medication', 'pills', 'size', 'side-effects', 'routine', 'blister' as well as secondary prevention medication terms.
Perceptions reducing the motivation to adhere included dealing with medication side effects, questioning doctors' prescribing practices and negative publicity about medications, especially in regard to statins. Caregivers faced difficulties with ensuring medications were taken while respecting the patient's decisions not to take tablets. They struggled in their role as advocates of patient's needs with healthcare professionals. Not experiencing side effects, attributing importance to medications, positive personal experiences of taking tablets and obtaining modification of treatment to manage side effects were facilitators of adherence. Key practical barriers included difficulties with swallowing tablets, dealing with the burden of treatment and drug cost. Using medication storage devices, following routines and getting help with medications from caregivers were important facilitators of adherence.
An online stroke forum is a novel and valuable resource to investigate use of secondary prevention medications. Analysis of this forum highlighted significant barriers and facilitators of medication adherence faced by stroke survivors and their caregivers. Addressing perceptual and practical barriers highlighted here can inform the development of future interventions aimed at improving adherence to secondary prevention medication after stroke.
确定中风患者及其护理人员在药物依从性方面的障碍和促进因素。
采用认知与实践方法，对有关二级预防药物的帖子进行定性主题分析。
2004年至2011年间，英国中风幸存者及其家庭成员在中风协会在线论坛上发布的帖子。
84名参与者，其中49名中风幸存者、33名护理人员、2名未说明身份，通过关键词“服药”“药片”“尺寸”“副作用”“日常安排”“泡罩包装”以及二级预防药物术语识别出来。
降低依从动机的认知包括应对药物副作用、质疑医生的开药习惯以及药物的负面宣传，尤其是他汀类药物。护理人员在确保患者服药的同时尊重患者不服药的决定方面面临困难。他们在作为患者需求倡导者与医护人员打交道时也很吃力。未出现副作用、重视药物、服药的积极个人经历以及获得治疗调整以管理副作用是依从性的促进因素。关键的实际障碍包括吞咽药片困难、应对治疗负担和药物成本。使用药物储存设备、遵循日常安排以及从护理人员处获得药物帮助是依从性的重要促进因素。
在线中风论坛是调查二级预防药物使用情况的一种新颖且有价值的资源。对该论坛的分析突出了中风幸存者及其护理人员在药物依从性方面面临的重大障碍和促进因素。解决此处强调的认知和实际障碍可为未来旨在提高中风后二级预防药物依从性的干预措施的制定提供参考。
