Behavioural Science Group, Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK.
BMJ Open. 2017 Aug 11;7(8):e015597. doi: 10.1136/bmjopen-2016-015597.
This study explored the reasons for patients' non-adherence to cardiometabolic medications, and tested the acceptability of the interactive voice response (IVR) as a way to address these reasons, and support patients, between primary care consultations.
DESIGN, METHOD, PARTICIPANTS AND SETTING: The study included face-to-face interviews with 19 patients with hypertension and/or type 2 diabetes mellitus, selected from primary care databases, and presumed to be non-adherent. Thirteen of these patients pretested elements of the IVR intervention few months later, using a think-aloud protocol. Five practice nurses were interviewed. Data were analysed using multiperspective, and longitudinalthematic analysis.
Negative beliefs about taking medications, the complexity of prescribed medication regimens, and the limited ability to cope with the underlying affective state, within challenging contexts, were mentioned as important reasons for non-adherence. Nurses reported time constraints to address each patient's different reasons for non-adherence, and limited efficacy to support patients, between primary care consultations. Patients gave positive experiential feedback about the IVR messages as a way to support them take their medicines, and provided recommendations for intervention content and delivery mode. Specifically, they liked the voice delivering the messages and the voice recognition software. For intervention content, they preferred messages that were tailored, and included messages with 'information about health consequences', 'action plans', or simple reminders for performing the behaviour.
Patients with hypertension and/or type 2 diabetes, and practice nurses, suggested messages tailored to each patient's reasons for non-adherence. Participants recommended IVR as an acceptable platform to support adherence to cardiometabolic medications between primary care consultations. Future studies could usefully test the acceptability, and feasibility, of tailored IVR interventions to support medication adherence, as an adjunct to primary care.
本研究探讨了患者不依从心血管代谢药物的原因，并测试了交互式语音应答（IVR）作为一种在初级保健咨询之间解决这些原因并支持患者的方法的可接受性。
设计、方法、参与者和设置：该研究包括面对面访谈 19 名高血压和/或 2 型糖尿病患者，这些患者从初级保健数据库中选择，被认为不依从。其中 13 名患者在几个月后使用出声思维协议预先测试了 IVR 干预措施的要素。采访了 5 名执业护士。使用多视角和纵向主题分析对数据进行分析。
患者提到，对服用药物的负面信念、处方药物方案的复杂性，以及在具有挑战性的环境中应对潜在情感状态的能力有限，是不依从的重要原因。护士报告说，他们在处理每个患者不依从的不同原因方面受到时间限制，并且在初级保健咨询之间支持患者的效果有限。患者对 IVR 消息作为支持他们服药的一种方式给予了积极的体验反馈，并对干预内容和传递模式提出了建议。具体来说，他们喜欢传达信息的声音和语音识别软件。对于干预内容，他们更喜欢量身定制的消息，并希望包含有关健康后果的信息、行动计划，或简单的提醒，以执行行为。
高血压和/或 2 型糖尿病患者和执业护士建议根据每个患者不依从的原因定制消息。参与者推荐 IVR 作为一种可接受的平台，可在初级保健咨询之间支持心血管代谢药物的依从性。未来的研究可以有效地测试个性化 IVR 干预措施在支持药物依从性方面的可接受性和可行性，作为初级保健的辅助手段。
