Forsyth Paul, Richardson Janice, Lowrie Richard
Pharmacy Services, NHS Greater Glasgow & Clyde.
Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Int J Pharm Pract. 2019 Oct;27(5):443-450. doi: 10.1111/ijpp.12511. Epub 2019 Jan 24.
Medication adherence is the end result of a complex set of interwoven factors. Non-adherence with medication in heart failure patients is associated with excess mortality and morbidity. Studies describing interventions to improve adherence in heart failure are limited by a lack of robust methods and inconsistent outcomes. The aim of this evaluation was to explore the barriers to medication adherence in Scottish heart failure patients in order to inform the development of complex interventions.
Qualitative patient interviews. Participants were aged ≥18 years with current or previous signs or symptoms of clinical heart failure, reduced left ventricular ejection fraction ≤45% and confirmed adherence of <80% in tablet counts of heart failure therapy. Thematic analysis was employed.
Eleven patients were recruited. The median age was 79 years old, and participants were typically from socially deprived communities. Participants were prescribed a mean 9.9 different medications per day. Seven distinct themes emerged around barriers to medication adherence: co-morbidity; treatment burden; health literacy; trust in NHS; socioeconomic factors; autonomy and health expectations.
The factors affecting medication adherence in heart failure are multi-factorial and are unlikely to be improved by one single-faceted intervention. Future interventions need to treat patients holistically, build their trust as partners, simplify complex treatment regimens where possible and involve educational and social elements. The skill set and opportunities afforded to pharmacists may be well placed to deliver many of these aspects but this would need tested in the context of the development of complex interventions.
药物依从性是一系列复杂交织因素的最终结果。心力衰竭患者不坚持服药与死亡率和发病率增加有关。描述改善心力衰竭患者依从性干预措施的研究受到缺乏有力方法和结果不一致的限制。本评估的目的是探讨苏格兰心力衰竭患者药物依从性的障碍，以便为制定综合干预措施提供依据。
进行定性患者访谈。参与者年龄≥18岁，有当前或既往临床心力衰竭的体征或症状，左心室射血分数降低≤45%，且在心力衰竭治疗药物计数中确认依从性<80%。采用主题分析法。
招募了11名患者。中位年龄为79岁，参与者通常来自社会贫困社区。参与者每天平均服用9.9种不同药物。围绕药物依从性障碍出现了七个不同的主题：合并症；治疗负担；健康素养；对国民保健制度的信任；社会经济因素；自主性和健康期望。
影响心力衰竭患者药物依从性的因素是多方面的，单一干预不太可能改善。未来的干预措施需要对患者进行全面治疗，建立他们作为合作伙伴的信任，尽可能简化复杂的治疗方案，并纳入教育和社会因素。药剂师所具备的技能和机会可能非常适合提供其中的许多方面，但这需要在综合干预措施的开发背景下进行测试。
