无干扰素丙型肝炎治疗的经验：解决依从性障碍并优化治疗效果。
Experiences with interferon-free hepatitis C therapies: addressing barriers to adherence and optimizing treatment outcomes.
作者信息
Skolnik Avy A, Noska Amanda, Yakovchenko Vera, Tsai Jack, Jones Natalie, Gifford Allen L, McInnes D Keith
机构信息
Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers VA Medical Center, 200 Springs Road (152), Bedford, MA, 01730, USA.
Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
出版信息
BMC Health Serv Res. 2019 Feb 1;19(1):91. doi: 10.1186/s12913-019-3904-9.
BACKGROUND
Millions of Americans are living with hepatitis C, the leading cause of liver disease in the United States. Medication treatment can cure hepatitis C. We sought to understand factors that contribute to hepatitis C treatment completion from the perspectives of patients and providers.
METHODS
We conducted semi-structured interviews at three Veterans Affairs Medical Centers. Patients were asked about their experiences with hepatitis C treatments and perspectives on care. Providers were asked about observations regarding patient responses to medications and perspectives about factors resulting in treatment completion. Transcripts were analyzed using a grounded thematic approach-an inductive analysis that lets themes emerge from the data.
RESULTS
Contributors to treatment completion included Experience with Older Treatments, Hope for Improvement, Symptom Relief, Tailored Organized Routines, and Positive Patient-Provider Relationship. Corresponding barriers also emerged, including pill burden and skepticism about treatment effectiveness and safety.
CONCLUSION
Despite the improved side-effect profile of newer HCV medications, multiple barriers to treatment completion remain. However, providers and patients were able to identify avenues for addressing such barriers.
背景
数百万美国人感染了丙型肝炎，这是美国肝病的主要病因。药物治疗可以治愈丙型肝炎。我们试图从患者和医疗服务提供者的角度了解促成丙型肝炎治疗完成的因素。
方法
我们在三个退伍军人事务医疗中心进行了半结构化访谈。询问患者他们的丙型肝炎治疗经历和对护理的看法。询问医疗服务提供者关于患者对药物反应的观察以及对导致治疗完成的因素的看法。使用扎根主题分析法对访谈记录进行分析——一种归纳分析方法，让主题从数据中浮现出来。
结果
促成治疗完成的因素包括旧治疗方法的经验、改善的希望、症状缓解、量身定制的有组织的日常安排以及积极的医患关系。相应的障碍也出现了，包括药丸负担以及对治疗有效性和安全性的怀疑。
结论
尽管新型丙型肝炎药物的副作用有所改善，但治疗完成仍存在多个障碍。然而，医疗服务提供者和患者能够确定解决此类障碍的途径。
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