Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway.
Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, 351 95 Växjö, Sweden.
Int J Nurs Stud. 2018 Dec;88:16-24. doi: 10.1016/j.ijnurstu.2018.07.013. Epub 2018 Jul 26.
Percutaneous coronary intervention is the most common therapeutic intervention for patients with narrowed coronary arteries due to coronary artery disease. Although it is known that patients with coronary artery disease often do not adhere to their medication regimen, little is known about what patients undergoing percutaneous coronary interventions find challenging in adhering to their medication regimen after hospital discharge.
To explore patients' experiences in adhering to medications following early post-discharge after first-time percutaneous coronary intervention.
An abductive qualitative approach was used to conduct in-depth interviews of patients undergoing first-time percutaneous coronary intervention.
Participants were recruited from a single tertiary university hospital, which services a large geographical area in western Norway. Patients fulfilling the inclusion criteria were identified through the Norwegian Registry for Invasive Cardiology.
Participants were patients aged 18 years or older who had their first percutaneous coronary intervention six to nine months earlier, were living at home at the time of study inclusion, and were prescribed dual antiplatelet therapy. Patients who were cognitively impaired, had previously undergone cardiac surgery, and/or were prescribed anticoagulation therapy with warfarin or novel oral anticoagulants were excluded. Purposeful sampling was used to include patients of different gender, age, and geographic settings. Twenty-two patients (12 men) were interviewed between December 2016 and April 2017.
Face-to-face semi-structured interviews were conducted, guided by a set of predetermined open-ended questions to gather patient experiences on factors relating to medication adherence or non-adherence. Transcribed interviews were analysed by qualitative content analysis.
Patients failed to adhere to their medication regimen for several reasons; intentional and unintentional reasons, multifaceted side effects from heart medications, scepticism towards generic drugs, lack of information regarding seriousness of disease after percutaneous coronary intervention, psychological impact of living with coronary artery disease, and these interacted. There were patients who felt that the medication information they received from physicians and nurses was uninformative and inadequate. Side effects from heart medications were common, ranging from minor ones to more disabling side effects, such as severe muscle and joint pain and fatigue. Patients found well established medication taking routines and aids to be necessary, and these improved adherence.
Patients undergoing first-time percutaneous coronary intervention face multiple, interacting challenges in trying to adhere to prescribed medications following discharge. This study highlights the need for a more structured follow-up care in order to improve medication adherence and to maximise their self-care abilities.
经皮冠状动脉介入治疗是治疗因冠状动脉疾病导致冠状动脉狭窄的患者最常用的治疗方法。虽然已知患有冠状动脉疾病的患者通常不遵守其药物治疗方案，但对于接受经皮冠状动脉介入治疗后的患者在出院后在遵守药物治疗方案方面遇到的挑战知之甚少。
探讨首次经皮冠状动脉介入治疗后早期出院患者在坚持药物治疗方面的经验。
采用归纳定性方法对首次经皮冠状动脉介入治疗的患者进行深入访谈。
参与者从挪威西部一个大型地理区域的一家单一的三级大学医院招募。通过挪威介入心脏病学登记处确定符合纳入标准的患者。
参与者为年龄在 18 岁或以上、在研究纳入时居住在自己家中、并接受双联抗血小板治疗的首次经皮冠状动脉介入治疗 6-9 个月后的患者。认知障碍、先前接受过心脏手术和/或接受华法林或新型口服抗凝剂抗凝治疗的患者被排除在外。采用目的性抽样方法纳入不同性别、年龄和地理环境的患者。2016 年 12 月至 2017 年 4 月期间对 22 名患者（12 名男性）进行了访谈。
进行面对面的半结构化访谈，由一组预定的开放式问题引导，以收集与药物依从性或不依从性相关的患者经验。对转录的访谈进行定性内容分析。
患者未能遵守其药物治疗方案有几个原因；有意和无意的原因、心脏药物的多方面副作用、对仿制药的怀疑、经皮冠状动脉介入治疗后对疾病严重性的信息不足、冠心病带来的心理影响，以及这些因素的相互作用。有些患者认为他们从医生和护士那里获得的药物信息没有信息量和不足。心脏药物的副作用很常见，从轻微到更严重的副作用，如严重的肌肉和关节疼痛和疲劳。患者发现建立良好的服药常规和辅助手段是必要的，这些措施可以提高依从性。
首次接受经皮冠状动脉介入治疗的患者在出院后试图坚持服用规定的药物时面临着多种相互作用的挑战。这项研究强调需要更结构化的随访护理，以提高药物依从性并最大限度地提高他们的自我护理能力。
