老年人对未控制 2 型糖尿病药物治疗依从性的看法：一项定性研究。
Perspectives of older people with uncontrolled type 2 diabetes mellitus towards medication adherence: A qualitative study.
机构信息
Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
出版信息
PLoS One. 2023 Aug 10;18(8):e0289834. doi: 10.1371/journal.pone.0289834. eCollection 2023.
BACKGROUND
Better medication adherence among people with diabetes mellitus was found to be associated with improved glycaemic control. However, medication non-adherence is a significant concern in older people with uncontrolled type 2 diabetes mellitus.
PURPOSE
To explore the perspectives of older people with uncontrolled type 2 diabetes mellitus towards medication adherence.
DESIGN
A qualitative descriptive exploratory study.
METHODOLOGY
A purposive sample of older people with uncontrolled type 2 diabetes mellitus living in the community was recruited. Snowball sampling was applied in community recruitment. In-depth telephone interviews were conducted using a semi-structured interview guide. Interviews were transcribed verbatim. Thematic analysis was used in data analysis. The consolidated criteria for reporting qualitative research (COREQ) guidelines were followed.
RESULTS
The emerged six themes were: (a) impact of knowledge, attitudes and practices on medication adherence, (b) treatment-related barriers to medication adherence, (c) impact of age-related changes on medication adherence, (d) person-related barriers to medication adherence, (e) impact of COVID-19 on medication adherence and, (f) role of support systems in medication adherence. Knowledge of the disease process and medications, attitudes towards medication adherence, the practice of different treatment approaches, self-medication and dosing, negative experiences related to medications, polypharmacy, changes in lifestyle and roles, the influence of work-life, motivation, negligence, family support, support received from health workers, facilities available and financial capability are the main factors influence medication adherence. Age-related memory impairment, visual disturbances and physical weaknesses affect medication adherence in older people. Additionally, COVID-19-related guidelines imposed by the government and healthcare system-related issues during the COVID-19 pandemic also affected medication adherence.
CONCLUSION
Adherence to medications among older people is hampered by a variety of factors, including their knowledge, attitudes and practices, person and treatment-related factors and age-related changes. The COVID-19 pandemic has brought additional challenges. Individualised patient care for older people with uncontrolled type 2 diabetes mellitus to improve medication adherence is timely. Strengthening support mechanisms for the above population is essential.
背景
研究发现，糖尿病患者的药物依从性提高与血糖控制改善有关。然而，在未控制的 2 型糖尿病老年患者中，药物不依从是一个严重的问题。
目的
探讨未控制的 2 型糖尿病老年患者对药物依从性的看法。
设计
定性描述性探索性研究。
方法
从社区中招募了未控制的 2 型糖尿病老年患者进行了有目的的抽样。在社区招募中应用了雪球抽样。使用半结构式访谈指南进行了深入的电话访谈。访谈逐字记录。数据分析采用主题分析。遵循了定性研究报告的统一标准（COREQ）指南。
结果
出现了六个主题：（a）知识、态度和实践对药物依从性的影响，（b）与治疗相关的药物依从性障碍，（c）与年龄相关的变化对药物依从性的影响，（d）与个人相关的药物依从性障碍，（e）COVID-19 对药物依从性的影响，以及（f）支持系统在药物依从性中的作用。对疾病过程和药物的了解、对药物依从性的态度、不同治疗方法的实践、自我用药和剂量、与药物相关的负面经验、多种药物治疗、生活方式和角色的变化、工作与生活的影响、动机、疏忽、家庭支持、从卫生工作者那里获得的支持、可利用的设施和经济能力是影响药物依从性的主要因素。与年龄相关的记忆障碍、视力障碍和身体虚弱会影响老年人的药物依从性。此外，政府实施的与 COVID-19 相关的指南和 COVID-19 大流行期间与医疗保健系统相关的问题也影响了药物的依从性。
结论
多种因素影响老年人对药物的依从性，包括他们的知识、态度和实践、个人和治疗相关因素以及与年龄相关的变化。COVID-19 大流行带来了额外的挑战。为改善未控制的 2 型糖尿病老年患者的药物依从性，需要个体化的患者护理。加强对上述人群的支持机制至关重要。
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