Trinkley Katy E, Kahn Michael G, Allen Larry A, Haugen Heather, Kroehl Miranda E, Lin Chen-Tan, Malone Daniel C, Matlock Daniel D
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Patient Prefer Adherence. 2020 Nov 10;14:2225-2230. doi: 10.2147/PPA.S276328. eCollection 2020.
Consideration of patient preferences for guideline-directed medical therapies (GDMT) for heart failure with reduced ejection fraction (HFrEF) may help improve major gaps in prescribing and adherence. This study aimed to identify the range and relative priority of factors influencing patients' decisions to take HFrEF medications.
This was a convergent mixed methods study of patients with HFrEF. Focus groups were conducted to identify a list of factors followed by individuals rating and ranking the influence of each factor on their decision to take a medication. Using thematic analysis, we summarized preferences into categories.
Two focus groups with 13 participants reported 22 factors. Of the factors, "keeping you alive" was most commonly ranked in the top three (seven participants), followed by "communication and understanding" (six participants). Factors were summarized into six categories (listed in order of patient-reported influence): 1) demonstrated improvements in quality of life and longevity, 2) decreased risk of hospitalization, 3) opportunity for shared decision-making and trust in provider, 4) absence of adverse events, 5) affordability, and 6) convenience of taking and absence of interference with daily life.
Patients prioritize treatment benefits and being informed more than risks, cost and inconvenience of taking HFrEF medications.
考虑患者对射血分数降低的心力衰竭（HFrEF）的指南指导药物治疗（GDMT）的偏好，可能有助于改善处方和依从性方面的重大差距。本研究旨在确定影响患者决定服用HFrEF药物的因素范围及相对优先级。
这是一项针对HFrEF患者的收敛性混合方法研究。进行焦点小组讨论以确定一系列因素，随后让个体对每个因素对其服药决定的影响进行评分和排序。通过主题分析，我们将偏好归纳为几类。
两个焦点小组的13名参与者报告了22个因素。在这些因素中，“维持生命”最常被排在前三位（7名参与者），其次是“沟通与理解”（6名参与者）。因素被归纳为六类（按患者报告的影响程度排序）：1）生活质量和寿命得到改善，2）住院风险降低，3）共同决策的机会以及对医疗服务提供者的信任，4）无不良事件，5）可承受性，6）服药便利性及对日常生活无干扰。
患者将治疗益处和信息告知置于优先地位，而非服用HFrEF药物的风险、成本和不便。
