James Delyth, Smith Joshua, Lane Emma, Thomas Rhian, Brown Sarah, Seage Heidi
Department of Applied Psychology, Cardiff School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff CF5 2YB, Wales, UK.
Cardiff School of Pharmacy & Pharmaceutical Sciences, Cardiff University, King Edward VIIth Avenue, Cardiff CF10 3NB, Wales, UK.
Explor Res Clin Soc Pharm. 2024 May 7;14:100450. doi: 10.1016/j.rcsop.2024.100450. eCollection 2024 Jun.
Parkinson's disease (PD) is a progressive neurodegenerative disease which primarily presents with the core symptoms of rigidity, postural instability, tremor, and bradykinesia. Non-adherence to prescribed PD treatments can have significant ramifications, such as poor symptom control and greater disease burden. Reasons for poor adherence are multifaceted, particularly when medication regimens are complex and often based on perceptual and practical barriers. Additionally, engaging fully non-adherent patients in research is challenging since they may have dropped out of service provision, yet their contribution is vital to fully understand the rationale for non-adherence. This paper aims to present a case study on the perspectives of one person with PD, a participant in a previously published qualitative study investigating the barriers and facilitators to medication adherence in PD. In this paper, the participant's diagnostic journey is described, and experiences of medical consultations are summarised to explain their reasons for not adhering to any of the standard UK PD treatments prescribed. The participant's preferences for using Vitamin B1 (thiamine) injections to manage the symptoms are reported and the rationale for doing so is discussed. We consider the case through the lens of a behavioural science approach, drawing on health psychology theory, the Theoretical Domains Framework (TDF), to inform the review and the practical challenges faced when analysing the data for this participant. Implications for pharmacy practice, in particular, are also put forward with view to ensuring that patients such as Mr. Wilkinson are provided with the opportunity to discuss treatment choices and self-management of long-term conditions such as PD. We also discuss the importance of reaching under-represented members of the population in medication adherence research, which embraces the principles of equality, diversity, and inclusion in research.
帕金森病（PD）是一种进行性神经退行性疾病，主要表现为僵硬、姿势不稳、震颤和运动迟缓等核心症状。不坚持帕金森病的规定治疗可能会产生重大影响，如症状控制不佳和疾病负担加重。依从性差的原因是多方面的，尤其是当药物治疗方案复杂且往往基于感知和实际障碍时。此外，让完全不依从的患者参与研究具有挑战性，因为他们可能已停止接受治疗服务，但其贡献对于充分理解不依从的原因至关重要。本文旨在呈现一个关于一名帕金森病患者观点的案例研究，该患者是先前发表的一项定性研究的参与者，该研究调查了帕金森病药物依从性的障碍和促进因素。本文描述了该参与者的诊断过程，并总结了其医疗咨询经历，以解释其不坚持任何英国规定的标准帕金森病治疗的原因。报告了该参与者使用维生素B1（硫胺素）注射来控制症状的偏好，并讨论了这样做的理由。我们通过行为科学方法的视角来审视这个案例，借鉴健康心理学理论、理论领域框架（TDF），为该案例的回顾以及分析该参与者数据时面临的实际挑战提供参考。特别是，还提出了对药学实践的启示，以期确保像威尔金森先生这样的患者有机会讨论治疗选择以及帕金森病等长期病症的自我管理。我们还讨论了在药物依从性研究中纳入代表性不足人群的重要性，这体现了研究中的平等、多样性和包容性原则。
