Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Health Expect. 2020 Dec;23(6):1485-1501. doi: 10.1111/hex.13133. Epub 2020 Oct 13.
The Assessing outcomes of enhanced Chronic disease Care through patient Education and a value-baSed formulary Study (ACCESS) is a randomized controlled trial evaluating two interventions targeting barriers to care among those at high risk of cardiovascular disease: copayment elimination for cardioprotective medications, and a tailored self-management support programme. We designed a process evaluation to better understand participant perspectives on the interventions.
We used a qualitative descriptive study design, collecting patient and pharmacist feedback via individual semi-structured telephone interviews and in-person focus groups. Data were analysed inductively using thematic analysis.
Fifty-three patients (39 interviews and 14 in two focus groups) and 20 pharmacists participated. Copayment elimination provided quality of life benefits: minimizing the need to 'cut-back', allowing 'peace of mind' and providing emotional support. Health-related benefits included: improving adherence to covered medications, and helping to afford non-covered goods. The only criticism was that not all medications and testing supplies were covered. Patients reported that the educational materials provided helpful information, acted as a reminder, improved confidence, improved adherence to medication, and helped initiate conversations with providers about indicated medication. Some participants felt that the educational materials were repetitive, overly medication-focused and not tailored enough. Pharmacists felt that their patients benefitted from both interventions, which improved patient adherence and communication with their patients.
The success of interventions intended to change behaviour is largely dependent upon participant's feelings that the intervention is helpful. This process evaluation provided insights into participants' perceptions on these interventions. Reception of both was largely positive with a few criticisms noted.
通过患者教育和基于价值的处方研究评估强化慢性病护理的结果（ACCESS）是一项随机对照试验，评估了两种针对心血管疾病高危人群护理障碍的干预措施：降低心脏保护药物的共付额，以及量身定制的自我管理支持计划。我们设计了一个过程评估，以更好地了解参与者对干预措施的看法。
我们使用定性描述性研究设计，通过个人半结构化电话访谈和现场焦点小组收集患者和药剂师的反馈。使用主题分析对数据进行归纳分析。
53 名患者（39 次访谈和 14 次在 2 个焦点小组中）和 20 名药剂师参与了研究。共付额减免提供了生活质量的好处：最大限度地减少了“削减”的需要，允许“安心”并提供情感支持。与健康相关的好处包括：提高对覆盖药物的依从性，并帮助支付非覆盖商品。唯一的批评是并非所有药物和测试用品都涵盖在内。患者报告说，提供的教育材料提供了有用的信息，起到了提醒作用，增强了信心，提高了对药物的依从性，并有助于与提供者就规定的药物进行对话。一些参与者认为教育材料过于重复、过于专注于药物，而且不够个性化。药剂师认为他们的患者从这两种干预措施中受益，这提高了患者的依从性和与患者的沟通。
改变行为的干预措施的成功在很大程度上取决于参与者认为干预措施有帮助的程度。这项过程评估提供了参与者对这些干预措施的看法的深入了解。两种干预措施都得到了广泛的好评，但也有一些批评意见。
