Morse Alan R, Seiple William H
Lighthouse Guild, New York, NY, USA.
Harkness Eye Institute, Columbia University, New York, NY, USA.
Clin Ophthalmol. 2020 Nov 2;14:3735-3739. doi: 10.2147/OPTH.S278627. eCollection 2020.
Adherence to medication treatment protocols and active participation by individuals in their medical care are important for all patients, but especially for those with chronic conditions such as vision loss. Adherence is crucial for decreasing avoidable vision loss. Failure to take medications as prescribed and keep scheduled appointments reduces treatment effectiveness, increases complications and results in poorer outcomes. Reasons for nonadherence vary by diagnosis and include not understanding the importance of adherence, low health literacy, lack of adequate self-efficacy, low level of activation and behavioral issues including depression. Patients may lack information about their condition and its prognosis, available treatment alternatives, and other essential information such as how to monitor their eye condition, what to do if vision deteriorates and how to get needed community-based help. Each of these factors impedes patients' ability to engage with their physician and participate in their own care. The ability of individuals with vision loss to actively and effectively manage their health care, ie, activation, has been understudied. When patients are involved with their own care, their care experience, and most importantly, their outcomes, are improved. Identifying antecedents of adherence may help provide disease- and patient-specific pathways to reduce avoidable vision loss.
坚持药物治疗方案以及患者积极参与自身医疗护理对所有患者都很重要，尤其是对于那些患有视力丧失等慢性病的患者。坚持治疗对于减少可避免的视力丧失至关重要。不按规定服药和不按时就诊会降低治疗效果，增加并发症，并导致更差的结果。不坚持治疗的原因因诊断而异，包括不理解坚持治疗的重要性、健康素养低、自我效能感不足、积极性不高以及包括抑郁症在内的行为问题。患者可能缺乏有关自身病情及其预后、可用治疗选择以及其他重要信息，例如如何监测眼部状况、视力恶化时该怎么做以及如何获得所需的社区帮助。这些因素中的每一个都会阻碍患者与医生沟通并参与自身护理的能力。视力丧失患者积极有效管理自身医疗护理的能力，即积极性，尚未得到充分研究。当患者参与自身护理时，他们的护理体验以及最重要的是他们的治疗结果都会得到改善。确定坚持治疗的先行因素可能有助于提供针对疾病和患者的特定途径，以减少可避免的视力丧失。
