Bartlett Ellis Rebecca J, Haase Joan E, Ruppar Todd M
Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA.
Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA.
Patient Prefer Adherence. 2023 Jan 24;17:239-248. doi: 10.2147/PPA.S387813. eCollection 2023.
Poor medication adherence is a significant problem, yet interventions to improve it have been largely ineffective. Existing ecological models indicate that adherence is multi-dimensional; however, they do not reflect understanding of context-specific processes and how they lead to adherence outcomes. A framework that reflects context-specific processes is important because it could be used to inform context-specific intervention delivery and measure associated adherence outcomes. The purpose of this paper is to describe the Medication Adherence Context and Outcomes (MACO) framework, which includes contexts (ie, clinics, pharmacies, and home) and context-specific processes (ie, shared decision-making, prescription filling strategies, home medication management) that lead to adherence outcomes (initiation, implementation, discontinuation, and persistence). The Medication and Adherence Contexts and Outcomes (MACO) framework was iteratively developed between 2015 and 2018 based on theory, practice, and research and combining patient experience journey mapping to chronologically describe the environmental contexts and actions (processes) that occur within the contexts and how they contribute to medication adherence as outcome. The three distinct yet interrelated contexts described in the MACO framework are 1) clinical encounters, 2) pharmacy encounters, and 3) day-to-day home management. Within these contexts are specific medication management actions that occur (processes) in order to produce adherence-related outcomes (initiation, implementation, and discontinuation/persistence). The MACO framework distinguishes context-specific processes and outcomes. The MACO framework may be useful to understand at which point(s) along the continuum people experience problems with managing medications. This understanding is potentially useful for developing and delivering context-specific interventions that are based on processes that underlie nonadherence and selecting adherence measures appropriate for the contexts.
用药依从性差是一个重大问题，但改善这一问题的干预措施在很大程度上效果不佳。现有的生态模型表明，依从性是多维度的；然而，它们没有反映对特定情境过程的理解以及这些过程如何导致依从性结果。一个反映特定情境过程的框架很重要，因为它可用于指导针对特定情境的干预措施实施，并衡量相关的依从性结果。本文的目的是描述用药依从性情境与结果（MACO）框架，该框架包括情境（即诊所、药房和家庭）以及导致依从性结果（起始、实施、停药和持续用药）的特定情境过程（即共同决策、处方配药策略、家庭用药管理）。用药与依从性情境及结果（MACO）框架在2015年至2018年期间基于理论、实践和研究进行了迭代开发，并结合患者体验旅程映射，按时间顺序描述环境情境以及情境中发生的行动（过程），以及它们如何促成用药依从性这一结果。MACO框架中描述的三个不同但相互关联的情境是：1）临床诊疗、2）药房配药、3）日常家庭管理。在这些情境中发生特定的用药管理行动（过程），以产生与依从性相关的结果（起始、实施和停药/持续用药）。MACO框架区分特定情境的过程和结果。MACO框架可能有助于理解人们在用药管理的连续过程中在哪些点上遇到问题。这种理解对于开发和实施基于不依从背后过程的特定情境干预措施以及选择适合这些情境的依从性衡量标准可能是有用的。
