Emamikia Sharzad, Gentline Cidem, Enman Yvonne, Parodis Ioannis
Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden.
Department of Rheumatology, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden.
J Clin Med. 2022 Mar 27;11(7):1857. doi: 10.3390/jcm11071857.
Medication non-adherence is common among patients with systemic lupus erythematosus (SLE) and may lead to poor clinical outcomes. Our aim was to identify influenceable contributors to medication non-adherence and suggest interventions that could increase adherence. Patients with SLE from two Swedish tertiary referral centres ( = 205) participated in a survey assessing self-reported adherence to medications. Responses were used to select patients for qualitative interviews ( = 15). Verbatim interview transcripts were analysed by two researchers using content analysis methodology. The median age of the interviewees was 32 years, 87% were women, and their median SLE duration was nine years. Reasons for non-adherence were complex and multifaceted; we categorised them thematically into (i) patient-related (e.g., unintentional non-adherence due to forgetfulness or intentional non-adherence due to disbelief in medications); (ii) healthcare-related (e.g., untrustworthy relationship with the treating physician, authority fear, and poor information about the prescribed medications or the disease); (iii) medication-related (e.g., fear of side-effects); and (iv) disease-related reasons (e.g., lacking acceptance of a chronic illness or perceived disease quiescence). Interventions identified that healthcare could implement to improve patient adherence to medications included (i) increased communication between healthcare professionals and patients; (ii) patient education; (iii) accessible healthcare, preferably with the same personnel; (iv) well-coordinated transition from paediatric to adult care; (v) regularity in addressing adherence to medications; (vi) psychological support; and (vii) involvement of family members or people who are close to the patient.
药物治疗不依从在系统性红斑狼疮（SLE）患者中很常见，可能导致不良的临床结局。我们的目的是确定导致药物治疗不依从的可影响因素，并提出可提高依从性的干预措施。来自瑞典两个三级转诊中心的205例SLE患者参与了一项评估自我报告药物治疗依从性的调查。根据调查结果选择患者进行定性访谈（15例）。两名研究人员采用内容分析法对访谈逐字记录进行分析。受访者的中位年龄为32岁，87%为女性，SLE中位病程为9年。不依从的原因复杂且多方面；我们将其主题分类为：（i）患者相关因素（例如，因遗忘导致的无意不依从或因对药物不信任导致的有意不依从）；（ii）医疗保健相关因素（例如，与主治医生的关系不可信、对权威的恐惧以及关于处方药或疾病的信息不足）；（iii）药物相关因素（例如，对副作用的恐惧）；以及（iv）疾病相关因素（例如，对慢性病缺乏接受度或认为疾病处于静止期）。确定的医疗保健机构可实施的改善患者药物治疗依从性的干预措施包括：（i）加强医疗保健专业人员与患者之间的沟通；（ii）患者教育；（iii）可及的医疗保健服务，最好由同一批人员提供；（iv）从儿科护理到成人护理的协调良好的过渡；（v）定期关注药物治疗依从性；（vi）心理支持；以及（vii）让家庭成员或患者身边的人参与进来。
