Read Simon, Waterman Heather, Morgan James E, Harper Robert A, Spencer Anne Fiona, Stanford Penelope
School of Healthcare Sciences, Cardiff University, Cardiff, UK,
School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
Patient Prefer Adherence. 2018 Jul 25;12:1315-1325. doi: 10.2147/PPA.S167080. eCollection 2018.
"She wouldn't remember. Even when I go through, and she's decided to go to bed, I'll say I'll come and do her drops. If I didn't say that, they wouldn't be done." Dementia is widely considered as a key factor in whether patients take their medication as prescribed. However, few studies have examined the effect of dementia on medication management strategies for glaucoma including how patient and carer needs impact adherence and long-term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers, and healthcare professionals.
Eighty-three semistructured interviews were conducted with 35 patients, 22 lay carers, and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers, and facilitators to drop administration, as well as attitudes toward glaucoma, dementia, and other comorbidities.
Using Pound's synthesis of adherence behavior, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg, heart disease, glaucoma, and dementia) and sociocultural influences (eg, living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioral changes influenced their administration.
Though dementia was associated with progression toward the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into preexisting routines.
“她不会记得的。即使我过去时她已经决定上床睡觉了，我也会说我会过来给她滴眼药。如果我不说，药就不会滴了。”痴呆症被广泛认为是患者是否按规定服药的关键因素。然而，很少有研究探讨痴呆症对青光眼药物管理策略的影响，包括患者和护理人员的需求如何影响依从性和长期预后。我们报告了一项定性扎根理论研究的结果，该研究纳入了患者、护理人员和医疗保健专业人员的观点。
在威尔士和苏格兰的多个地点，对35名患者、22名非专业护理人员和9名医疗保健专业人员进行了83次半结构化访谈。这些访谈探讨了对滴眼药方案的理解、滴眼药的障碍和促进因素，以及对青光眼、痴呆症和其他合并症的态度。
使用庞德对依从行为的综合分析，我们确定了主动和被动接受药物的类别，以及对滴眼药方案的修改或拒绝。关于痴呆症，参与者强调了这些类别之间的转变，通常报告从主动接受转变为被动接受。这种自我给药能力的丧失被称为护理的悬崖，多种疾病（如心脏病、青光眼和痴呆症）和社会文化影响（如独居）的交织导致健康加速衰退。也就是说，许多因素减轻了这种情况，其中关键角色是非专业护理人员。配偶和家庭成员经常充当患者滴眼药的监督者，当任何行为变化影响滴眼药时寻求干预。
虽然痴呆症与向护理悬崖的进展有关，但与医疗保健专业人员的沟通等因素似乎会影响患者的依从性。对医疗实践的建议包括更好地记录痴呆症诊断，并将滴眼药纳入现有的日常护理中。
