Frigaard Christine, Menichetti Julia, Schirmer Henrik, Bjørnstad Herman, Breines Simonsen Tone, Wisløff Torbjørn, Gulbrandsen Pål, Gerwing Jennifer
Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
BMJ Open. 2024 Aug 7;14(8):e086440. doi: 10.1136/bmjopen-2024-086440.
The main objective of this study was twofold: to investigate what kind of information patients with heart failure (HF) tell their doctors about their medication adherence at home, and how often such information is provided in consultations where medication reconciliation is recommended. To meet these objectives, we developed an analysis to recognise, define, and count (1) patient utterances including medication adherence disclosures in clinical interactions (MADICI), (2) MADICI including red-flags for non-adherence, and (3) MADICI initiated by patients without prompts from their doctor.
Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient-doctor consultations, audio-recorded at three time-points for each patient: (1) first ward visit in hospital, (2) discharge visit from hospital, and (3) follow-up visit with general practitioner (GP).
Norway (2022-2023).
25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs).
We recognised MADICI by two criteria: (1) they are about medication prescribed for use at home, AND (2) they involve patients' action, experience, or stance regarding medications. Using these criteria, we identified 427 MADICIs in 25 patient trajectories: 143 (34%) at first ward visit (min-max=0-35, median=3), 57 (13%) at discharge visit (min-max=0-8, median=2), 227 (53%) at GP-visit (min-max=2-24, median=7). Of 427 MADICIs, 235 (55%) included red-flags for non-adherence. Bumetanide and atorvastatin were most frequently mentioned as problematic. Patients initiated 146 (34%) of 427 MADICIs. Of 235 'red-flag MADICIs', 101 (43%) were initiated by patients.
Self-managing older patients with HF disclosed information about their use of medications at home, often including red-flags for non-adherence. Patients who disclosed information that signals adherence problems tended to do so unprompted. Such disclosures generate opportunities for doctors to assess and support patients' medication adherence at home.
本研究的主要目的有两个：一是调查心力衰竭（HF）患者在家中向医生告知其用药依从性的信息类型，二是在建议进行用药核对的会诊中，此类信息的提供频率。为实现这些目标，我们开展了一项分析，以识别、定义和统计：（1）临床互动中包括用药依从性披露的患者话语（MADICI），（2）包括不依从警示信号的MADICI，以及（3）患者在未得到医生提示的情况下主动提及的MADICI。
基于探索性互动的观察性队列研究。对真实的医患会诊进行归纳性微观分析，每个患者在三个时间点进行录音：（1）首次住院病房就诊，（2）出院就诊，以及（3）全科医生（GP）随访就诊。
挪威（2022 - 2023年）。
25名65岁及以上的HF患者及其主治医生（23名医院医生，25名全科医生）。
我们通过两个标准识别MADICI：（1）它们是关于在家中使用的处方药，并且（2）它们涉及患者对药物的行动、经验或态度。使用这些标准，我们在25条患者病程中识别出427条MADICI：首次病房就诊时143条（34%）（最小 - 最大 = 0 - 35，中位数 = 3），出院就诊时57条（13%）（最小 - 最大 = 0 - 8，中位数 = 2），全科医生随访就诊时227条（53%）（最小 - 最大 = 2 - 24，中位数 = 7）。在427条MADICI中，235条（55%）包括不依从警示信号。布美他尼和阿托伐他汀被提及为问题最多的药物。患者主动提及了427条MADICI中的146条（34%）。在235条“警示信号MADICI”中，101条（43%）是由患者主动提及的。
自我管理的老年HF患者披露了他们在家中用药的信息，通常包括不依从警示信号。披露表明存在依从性问题信息的患者往往是在未得到提示的情况下这样做的。此类披露为医生提供了在家中评估和支持患者用药依从性的机会。
