Pithara Christalla, Pufulete Maria, Johnson Thomas W, Redwood Sabi
National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Population Health Sciences, University of Bristol, Bristol, UK.
Open Heart. 2020 Oct;7(2). doi: 10.1136/openhrt-2020-001405.
To understand the experiences of patients with dual antiplatelet therapy (DAPT) and nuisance bleeding, and their perspectives of the impact of nuisance bleeding on medication adherence and information seeking.
We conducted focus groups with patients who had undergone percutaneous coronary intervention, coronary artery bypass graft and conservatively managed acute coronary syndrome patients. Two focus groups were with patients at the early stages of treatment (0-3 months), and two with patients coming to the end of treatment (9-12 months). Group discussions were audio recorded, and recordings were transcribed verbatim, anonymised and analysed using framework analysis.
Nine patients taking DAPT for up to 3 months, and 12 taking DAPT between 9 and 12 months participated in the focus groups. We found that: (1) participants adhered to treatment when they believed DAPT was important to health outcomes; (2) those who experienced nuisance bleeding reported symptoms to be mild and manageable; (3) participants' and their family's understanding of DAPT risks and benefits, and their ability to manage symptoms, influenced perspectives of and experiences with adherence. Factors influencing DAPT knowledge included access to medication counselling, engaging with information communicated during medication counselling, and access to timely, relevant and expert information and advice after discharge from hospital.
Positive attitudes towards adherence were facilitated by knowledge and understanding of DAPT and confidence in dealing with symptoms caused by DAPT, but hindered by lack of opportunities to access relevant, timely and appropriate medication counselling. Education interventions should aim to support medication literacy through family-centred approaches and involve patients and families at all stages of intervention design and evaluation.
了解接受双重抗血小板治疗（DAPT）且发生烦扰性出血的患者的经历，以及他们对烦扰性出血对药物依从性和信息寻求影响的看法。
我们对接受经皮冠状动脉介入治疗、冠状动脉旁路移植术的患者以及采用保守治疗的急性冠状动脉综合征患者进行了焦点小组访谈。两个焦点小组由处于治疗早期（0 - 3个月）的患者组成，另外两个由接近治疗尾声（9 - 12个月）的患者组成。小组讨论进行了录音，录音逐字转录、匿名处理，并采用框架分析法进行分析。
9名接受DAPT治疗长达3个月的患者以及12名在9至12个月期间接受DAPT治疗的患者参与了焦点小组访谈。我们发现：（1）当参与者认为DAPT对健康结果很重要时，他们会坚持治疗；（2）经历烦扰性出血的患者报告症状轻微且可控；（3）参与者及其家人对DAPT风险和益处的理解以及他们管理症状的能力，影响了对依从性的看法和经历。影响DAPT知识的因素包括获得药物咨询、理解药物咨询中传达的信息，以及出院后获得及时、相关且专业的信息和建议。
对DAPT的了解和认识以及应对DAPT所致症状的信心有助于形成积极的依从态度，但缺乏获得相关、及时和适当药物咨询的机会会对此产生阻碍。教育干预应旨在通过以家庭为中心的方法支持药物素养，并让患者及其家人参与干预设计和评估的各个阶段。
