Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA.
BMC Pulm Med. 2022 Mar 19;22(1):98. doi: 10.1186/s12890-022-01892-5.
Medication adherence in chronic obstructive pulmonary disease (COPD) is low, though not enough is known about the factors that affect adherence in COPD. This study uses qualitative methods to understand the patient perspective on facilitators and barriers to medication adherence in COPD as well as patient-reported strategies for self-management of disease.
Semi-structured interviews were conducted with 30 individuals (n = 30). Transcripts were analyzed using iterative qualitative coding by 2 independent coders, and codes were categorized using thematic analysis.
Challenges with adherence reported were gaps in understanding, forgetfulness of the patient, physician availability, cost navigation, and overcoming substance use. Most commonly, the financial burden of COPD medications caused patients to source other countries to obtain medications, rely on sample medications collected during doctors' visits, and to alter medication dosage and frequency to extend the length of a prescription. Tools and resources reported by patients to support self-management of COPD included pharmacist assistance, physician office information, and community resources. Individuals further reported that the use of logs or diaries to track medication usage, visual or temporal cues to take medications, and support from family members were helpful in promoting adherence to their COPD medication regimen.
Medication adherence in individuals with COPD is affected by challenges with self-management of disease and financial burden of medications. However, patients reported multiple tools and resources to support adherence. Physician recognition of these factors impacting self-management, as well as awareness of strategies to promote adherence and manage disease, may improve patient outcomes.
慢性阻塞性肺疾病（COPD）患者的药物依从性较低，但对于影响 COPD 患者药物依从性的因素了解甚少。本研究采用定性方法，从患者角度了解 COPD 患者药物依从性的促进因素和障碍因素，以及患者自我管理疾病的报告策略。
对 30 名个体（n=30）进行了半结构化访谈。两名独立编码员使用迭代定性编码对转录本进行分析，并使用主题分析对代码进行分类。
报告的依从性挑战包括理解上的差距、患者健忘、医生可用性、成本导航以及克服药物滥用。最常见的是，COPD 药物的经济负担导致患者从其他国家获取药物，依赖于医生就诊时收集的样本药物，以及改变药物剂量和频率以延长处方的长度。患者报告支持 COPD 自我管理的工具和资源包括药剂师协助、医生办公室信息和社区资源。个人进一步报告说，使用日志或日记来跟踪药物使用情况、使用视觉或时间提示来服用药物以及家庭成员的支持有助于促进他们对 COPD 药物治疗方案的依从性。
COPD 患者的药物依从性受到疾病自我管理和药物经济负担的挑战的影响。然而，患者报告了多种支持依从性的工具和资源。医生认识到这些影响自我管理的因素，以及提高依从性和管理疾病的策略的意识，可能会改善患者的预后。
