药物依从性的障碍与促进因素:一项针对全科医生的定性研究

Barriers and facilitators to medication adherence: a qualitative study with general practitioners.

作者信息

Kvarnström Kirsi, Airaksinen Marja, Liira Helena

机构信息

Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland.

General Practice, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.

出版信息

BMJ Open. 2018 Jan 23;8(1):e015332. doi: 10.1136/bmjopen-2016-015332.

Abstract

BACKGROUND

General practitioners (GPs) manage the drug therapies of people with chronic diseases, and poor adherence to medication remains a major challenge.

OBJECTIVE

This qualitative study examined GPs' insights into non-adherence and ways of overcoming this problem.

METHODS

We ran four focus groups comprising 16 GPs at the Kirkkonummi Health Centre (Southern Finland). Interviews were audiotaped, transcribed verbatim and analysed by inductive content analysis.

MAIN RESULTS

The two main themes in the discussions with the GPs were non-adherence in the care of chronic disease and increased need for medicine information. The medication management challenges identified were related to: patient-specific factors, the healthcare system, characteristics of drug therapies and the function and role of healthcare professionals as a team. To improve the situation, the GPs offered a number of solutions: improved coordination of care, better patient education and IT systems as well as enhanced interprofessional involvement in the follow-up of patients.

DISCUSSION AND CONCLUSIONS

With an ageing population, the GPs were increasingly confronted with non-adherence in the care of chronic diseases. They had mostly a positive attitude towards organising care in a more interprofessional manner. To support medication adherence and self-management, the GPs appreciated pharmacists' assistance especially with patients with polypharmacy and chronic diseases.

摘要

背景

全科医生负责管理慢性病患者的药物治疗,而药物治疗依从性差仍是一项重大挑战。

目的

这项定性研究探讨了全科医生对治疗不依从性的见解以及克服这一问题的方法。

方法

我们在芬兰南部基尔科努米健康中心组织了由16名全科医生组成的4个焦点小组。访谈进行了录音,逐字转录,并采用归纳性内容分析法进行分析。

主要结果

与全科医生讨论的两个主要主题是慢性病护理中的治疗不依从性以及对药物信息需求的增加。确定的药物管理挑战与以下方面有关:患者个体因素、医疗保健系统、药物治疗特点以及医疗保健专业人员作为一个团队的职能和作用。为改善这种情况,全科医生提出了一些解决方案:改善护理协调、加强患者教育和信息技术系统,以及增强跨专业人员对患者随访的参与。

讨论与结论

随着人口老龄化,全科医生在慢性病护理中越来越多地面临治疗不依从性问题。他们大多对以更跨专业方式组织护理持积极态度。为支持药物治疗依从性和自我管理,全科医生尤其赞赏药剂师对多重用药和慢性病患者的帮助。

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