Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.
Environmental and Natural Resources Center (CERENA), University of Lisbon, Higher Technical Institute, Lisbon, Portugal.
Int J Clin Pharm. 2021 Jun;43(3):629-636. doi: 10.1007/s11096-020-01174-2. Epub 2020 Oct 26.
Although much is known about cardiovascular patients' medication adherence, the extent to which clinicians perceive non-adherence as a barrier in clinical practice is little explored. Objective To evaluate knowledge and awareness about potential barriers to medication adherence, and to evaluate strategies used in clinical practice by Portuguese clinicians on how to foster medication adherence of patients undergoing secondary cardiovascular prevention. Setting Nominal Group Technique (NGT) at the University of Lisbon; online survey addressed to physicians working in primary and secondary care in Portugal. Method A narrative literature review was conducted in Pubmed to identify studies describing interventions targeted at physicians to manage medication adherence. The NGT included 12 allied healthcare professionals with recognized expertise in medication adherence and was organised in four phases, resulting in survey development. The survey was used in a cross-sectional national study where clinicians reported their knowledge and perceptions about patients' medication adherence and their daily practice. Main outcome measures Knowledge and awareness about barriers to medication adherence; and practice patterns. Results A total of 296 papers were identified, 26 of which were included. Four main topics were selected to be used in the NGT: adherence determinants, detecting non-adherence, fostering adherence, and educating physicians. NGT resulted in a survey, reaching 451 physicians, mostly practicing in primary care. Most had specific education on medication adherence and considered patient interviews and prescription records the most useful assessment methods. Nonetheless, many recognised often using clinical judgement to evaluate adherence in practice. Barriers to medication adherence were perceived to occur often during implementation. Most perceived reasons for uncontrolled hypertension were non-adherence to lifestyle recommendations and to medication. Less than half the physicians asked their patients if medication was taken. More useful enabling strategies included reducing daily doses, reviewing therapeutic options and motivational interventions. Conclusions Clinicians seem well informed about the importance of medication adherence and aware of problems encountered in practice. Limited time during medical appointment may be a barrier for better patient support.
尽管人们对心血管病患者的用药依从性有了很多了解，但临床医生在多大程度上认为不依从是临床实践中的一个障碍，这方面的研究还很少。目的评估葡萄牙临床医生对药物治疗依从性潜在障碍的认识和了解程度，并评估他们在临床实践中用于促进接受二级心血管预防的患者药物治疗依从性的策略。地点在里斯本大学进行名义小组技术（NGT）；向葡萄牙初级和二级保健机构的医生进行在线调查。方法在 Pubmed 上进行了一项描述针对医生的干预措施以管理药物治疗依从性的研究的叙述性文献综述。NGT 包括 12 名具有药物治疗依从性专业知识的医疗保健专业人员，共分为四个阶段，最终形成了调查的开发。该调查用于一项全国性的横断面研究，临床医生报告了他们对患者药物治疗依从性的知识和看法以及他们的日常实践。主要结果指标对药物治疗依从性障碍的认识和了解；以及实践模式。结果共确定了 296 篇论文，其中 26 篇被纳入。选择了四个主要主题用于 NGT：依从性决定因素、检测不依从性、促进依从性和教育医生。NGT 产生了一份调查，共涉及 451 名医生，他们主要在初级保健机构工作。大多数人接受过药物治疗依从性的专门教育，并认为患者访谈和处方记录是最有用的评估方法。尽管如此，许多人承认在实践中经常使用临床判断来评估依从性。药物治疗依从性的障碍被认为在实施过程中经常发生。大多数人认为控制不佳的高血压的原因是不遵守生活方式建议和药物治疗。不到一半的医生询问患者是否服药。更有用的辅助策略包括减少每日剂量、审查治疗选择和动机干预。结论临床医生似乎对药物治疗依从性的重要性有很好的了解，并且对实践中遇到的问题有认识。在就诊期间，时间有限可能是更好地支持患者的障碍。
