Hamilton Jane E, Blanco Eduardo, Selek Salih, Wirfel Kelly L, Bernstam Elmer V, Velligan Dawn, Gudala Meghana, Roberts Kirk
The University of Texas Health Science Center at Houston, McGovern Medical School, Louis Faillace Department of Psychiatry and Behavioral Sciences, Houston, TX, USA.
Arizona State University, School of Computing and Augmented Intelligence, Tempe, AZ, USA.
Patient Prefer Adherence. 2022 Jun 30;16:1581-1594. doi: 10.2147/PPA.S328785. eCollection 2022.
Diabetes and depression affect a significant percentage of the world's total population, and the management of these conditions is critical for reducing the global burden of disease. Medication adherence is crucial for improving diabetes and depression outcomes, and research is needed to elucidate barriers to medication adherence, including the intentionality of non-adherence, to intervene effectively. The purpose of this study was to explore the perspectives of patients and health care providers on intentional and unintentional medication adherence among patients with depression and diabetes through a series of focus groups conducted across clinical settings in a large urban area.
This qualitative study utilized a grounded theory approach to thematically analyze qualitative data using the framework method. Four focus groups in total were conducted, two with patients and two with providers, over a one-year period using a semi-structured facilitation instrument containing open-ended questions about experiences, perceptions and beliefs about medication adherence.
Across the focus groups, communication difficulties between patients and providers resulting in medication non-adherence was a primary theme that emerged. Concerns about medication side effects and beliefs about medication effectiveness were identified as perceptual barriers related to intentional medication non-adherence. Practical barriers to medication adherence, including medication costs, forgetting to take medications and polypharmacy, emerged as themes related to unintentional medication non-adherence.
The study findings contribute to a growing body of research suggesting health system changes are needed to improve provider education and implement multicomponent interventions to improve medication adherence among patients with depression and/or diabetes, both chronic illnesses accounting for significant disease burden globally.
糖尿病和抑郁症影响着全球相当大比例的人口，对这些疾病的管理对于减轻全球疾病负担至关重要。药物依从性对于改善糖尿病和抑郁症的治疗效果至关重要，需要开展研究以阐明药物依从性的障碍，包括不依从的意图，以便有效地进行干预。本研究的目的是通过在一个大城市的临床环境中开展的一系列焦点小组讨论，探讨抑郁症和糖尿病患者以及医疗服务提供者对有意和无意药物依从性的看法。
这项定性研究采用扎根理论方法，使用框架法对定性数据进行主题分析。在一年的时间里，总共进行了四个焦点小组讨论，其中两个是与患者进行的，两个是与提供者进行的，使用了一个半结构化的引导工具，其中包含关于药物依从性的经历、看法和信念的开放式问题。
在各个焦点小组中，患者与提供者之间因沟通困难导致药物不依从是出现的一个主要主题。对药物副作用的担忧和对药物疗效的看法被确定为与有意药物不依从相关的认知障碍。药物依从性的实际障碍，包括药物成本、忘记服药和多重用药，成为与无意药物不依从相关的主题。
该研究结果有助于越来越多的研究表明，需要改变卫生系统，以改善提供者教育并实施多组分干预措施，以提高抑郁症和/或糖尿病患者的药物依从性，这两种慢性病在全球造成了重大的疾病负担。
