Kamath D Y, Bhuvana K B, Dhiraj R S, Xavier D, Varghese K, Salazar L J, Granger C B, Pais P, Granger B B
Department of Pharmacology, St. John's National Academy of Health Sciences, Bangalore, 560034, India.
Division of Clinical Research and Training, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, 560034, India.
Wellcome Open Res. 2020 Mar 10;5:10. doi: 10.12688/wellcomeopenres.15485.2. eCollection 2020.
: Adherence to a complex, yet effective medication regimen improves clinical outcomes in patients with chronic heart failure (CHF). However, patient adherence to an agreed upon plan for medication-taking is sub-optimal and continues to hover at 50% in developed countries. Studies to improve medication-taking have focused on interventions to improve adherence to guideline-directed medication therapy, yet few of these studies have integrated patients' perceptions of what constitutes effective strategies for improved medication-taking and self-care in everyday life. The purpose of this formative study was to explore patient perceived facilitators of selfcare and medication-taking in South Asian CHF patients. : We conducted in-depth interviews of patients with long standing heart failure admitted to the cardiology and internal medicine wards of a South Indian tertiary care hospital. We purposively sampled using the following criteria: sex, socio-economic status, health literacy and patient reported medication adherence in the month prior to hospitalization. We employed inductive coding to identify facilitators. At the end of 15 interviews (eight patients and seven caregivers; seven patient-caregiver dyads), we arrived at theoretical saturation for facilitators. : Facilitators could be classified into intrinsic (patient traits - situational awareness, self-efficacy, gratitude, resilience, spiritual invocation and support seeking behavior) and extrinsic (shaped by the environment - financial security and caregiver support, company of children, ease of healthcare access, trust in provider/hospital, supportive environment and recognizing the importance of knowledge). We identified and classified a set of key patient and caregiver reported self-care facilitators among Indian CHF patients. The learnings from this study will be incorporated into an intervention package to improve patient engagement, overall self-care and patient-caregiver-provider dynamics.
坚持复杂但有效的药物治疗方案可改善慢性心力衰竭（CHF）患者的临床结局。然而，患者对商定的服药计划的依从性并不理想，在发达国家仍徘徊在50%。改善服药情况的研究主要集中在干预措施上，以提高对指南指导的药物治疗的依从性，但这些研究中很少有将患者对日常生活中改善服药和自我护理的有效策略的看法纳入其中。这项形成性研究的目的是探索南亚CHF患者自我护理和服药的促进因素。
我们对一家南印度三级护理医院心脏病科和内科病房收治的长期心力衰竭患者进行了深入访谈。我们根据以下标准进行了有目的的抽样：性别、社会经济地位、健康素养以及患者报告的住院前一个月的药物依从性。我们采用归纳编码来确定促进因素。在进行了15次访谈（8名患者和7名护理人员；7对患者-护理人员）后，我们在促进因素方面达到了理论饱和。
促进因素可分为内在因素（患者特质——情境意识、自我效能感、感恩、恢复力、精神诉求和寻求支持行为）和外在因素（由环境塑造——经济保障和护理人员支持、子女陪伴、就医便利、对提供者/医院的信任、支持性环境以及认识到知识的重要性）。我们在印度CHF患者中确定并分类了一组关键的患者和护理人员报告的自我护理促进因素。本研究的成果将纳入一个干预方案，以提高患者参与度、整体自我护理以及患者-护理人员-提供者之间的互动。
