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ABSTRACT Background: To examine the impact of pharmacist counseling and follow-up on patient's medication compliance and Helicobacter Pylori (H. pylori) eradication and evaluate the efficiency of an eradication regimen consisting of Clarithromycin 500 mg, Amoxicillin 1 g, and Lansoprazole 30 mg, twice daily for 14 days. Methods: Two hundred patients undergoing endoscopy and positive rapid urease tests were included in the present study. Patients were randomly divided into two groups: an intervention group (n=100) and a control group (n=100). The intervention patients obtained their medications from the hospital pharmacist and received sufficient counseling and follow-up. On the other hand, the control patients received their medications from another hospital pharmacist and went through the routine hospital procedure without good counseling and follow-up. Results: The intervention resulted in a statistically significant improvement in outpatient compliance with medication (45.0% vs 27.5%; P<0.05) and eradication of H. pylori (28.5% vs 42.5%; P<0.05) among those patients. Conclusion: This study reflects the importance of pharmacist counseling and patient compliance to medication, as the patients who received pharmacist counseling exhibited perfect compliance to medication, which led to the successful eradication of H. pylori.
RESUMO Contexto: Analisar o impacto do aconselhamento e acompanhamento farmacêutico na adesão medicamentosa do paciente e na erradicação do Helicobacter Pylori (H. pylori) e avaliar a eficiência de um regime de erradicação composto por Claritromicina 500 mg, Amoxicilina 1 g e Lansoprazol 30 mg, duas vezes ao dia por 14 dias. Métodos Duzentos pacientes submetidos à endoscopia e testes rápidos de urease positivos foram incluídos no presente estudo. Os pacientes foram divididos aleatoriamente em dois grupos: um grupo intervenção (n=100) e um grupo controle (n=100). Os pacientes de intervenção obtiveram seus medicamentos do farmacêutico do hospital e receberam aconselhamento e acompanhamento suficientes. Por outro lado, os pacientes do grupo controle receberam seus medicamentos de outro farmacêutico hospitalar e passaram pelo procedimento hospitalar de rotina sem um bom aconselhamento e acompanhamento. Resultados: A intervenção do farmacêutico resultou em melhora estatisticamente significativa na adesão ambulatorial à medicação (45,0% vs 27,5%; P<0,05) e na erradicação de H. pylori (28,5% vs 42,5%; P<0,05) entre esses pacientes. Conclusão Este estudo reflete a importância do aconselhamento farmacêutico e da adesão do paciente à medicação, uma vez que os pacientes que receberam aconselhamento farmacêutico apresentaram perfeita adesão à medicação, o que levou à erradicação bem-sucedida da H. pylori.
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Objective:To investigate the effects of rehabilitation education guided by the information-motivation-behavior (IBM) model on knowledge, attitude and practice in patients with schizophrenia.Methods:The clinical data of 109 patients with schizophrenia who received treatment in Taizhou Second People's Hospital from January 2020 to June 2021 were retrospectively analyzed. These patients were divided into study group ( n = 59) and control group ( n = 50) according to different intervention methods. The control group was treated with routine health education, and the study group was treated with IBM model-induced knowledge, attitude and practice intervention. After 3 months of intervention, the Positive and Negative Syndrome Scale, the Morisky self-reported Adherence Questionnaire score, Attentional Control Scale, Family Adaptation, Partnership, Growth, Affection, Resolve Scale, and the Personal and Social Performance Scale scores were compared between the two groups. Results:After intervention, positive symptom score, negative symptom score, and total Positive and Negative Syndrome Scale score in the study group were (10.15 ± 2.20) points, (11.49 ± 2.38) points, and (64.22 ± 9.40) points, respectively, which were significantly lower than (13.68 ± 2.71) points, (14.72 ± 2.45) points, (72.57 ± 9.58) points in the control group ( t = 7.50, 6.96, 4.58, all P < 0.001). After intervention, the Morisky self-reported Adherence Questionnaire score in the study group was significantly lower than that in the control group [(1.09 ± 0.27) points vs. (1.45 ± 0.39) points, t = 5.66, P < 0.001]. Attentional Control Scale, Family Adaptation, Partnership, Growth, Affection, Resolve Scale and the Personal and Social Performance Scale scores in the study group were (62.20 ± 7.31) points, (11.26 ± 2.24) points and (52.02 ± 5.50) points, respectively, which were significantly higher than (54.75 ± 6.68) points, (9.80 ± 2.13) points, (48.78 ± 5.31) points in the control group ( t = 5.51, 3.46, 3.11, all P < 0.05). Conclusion:Information-motivation-behavior model-guided knowledge, attitude and practice intervention can remarkably improve the mental state of patients with schizophrenia, improve attention control and medication adherence, and thereby improve their family function and social function.
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Objective:To explore the risk factors of antiplatelet drug compliance after stent implantation in patients with lower extremity arteriosclerosis obliterans, and to construct an online prediction model tool.Methods:Retrospective analysis of the clinical data of patients with lower extremity arteriosclerosis obliterans who received lower extremity arterial stent implantation in Department of Vascular Surgery, Provincial Hospital Affiliated to Shangdong First Medical University from January 2019 to January 2021 was carried out. 90 patients with poor compliance and 90 patients with good compliance were selected into the observation group and the control group, respectively. Univariate analysis was used to screen the influencing factors of antiplatelet drug compliance, and the variables with statistical significance were substituted into the binary Logistic regression to carry out independent risk factor test to screen the risk factors of cross-over antiplatelet drug compliance and establish the prediction model.Results:Married ( OR = 0.316, 95% CI 0.135-0.738), number of follow-up visits during the follow-up period ( OR = 0.866, 95% CI 0.760-0.987), the amount of medication ( OR = 0.755, 95% CI 0.654-0.919) were the protective factors for the compliance of antiplatelet drugs in patients with lower extremity arteriosclerosis obliterans after stent implantation. Advanced age ( OR = 1.136, 95% CI 1.066-1.211), male ( OR = 3.727, 95% CI 1.533-9.060), junior high school and below education level ( OR = 4.949, 95% CI 1.501-16.313), the average monthly income less than 3 000 yuan ( OR = 15.774, 95% CI 4.487-55.495) and the monthly expenditure on medicine more than 500 yuan ( OR = 15.323, 95% CI 3.527-66.569) were the risk factors for the compliance of antiplatelet drugs in patients with lower extremity arteriosclerosis obliterans after stent implantation. The consistency index of this prediction model was 0.895, the area under the ROC curve was 0.875. Conclusion:The antiplatelet medication adherence prediction model established has high accuracy and good clinical application values.
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Objective:To explore the effect of solution-focused approach on medication adherence in patients with cerebral ischemic stroke.Methods:A total of 120 patients with cerebral ischemic stroke from May to August 2019 in the Second Affiliated Hospital of Harbin Medical University were divided into the experimental group and the control group by random digits table method with 60 cases in each group. The patients in the control group received the routine nursing in the hospital and extended nursing outside the hospital, while patients in the experimental group received the solution-focused approach based on the control group. The intervention effects of the two groups were evaluated by Morisky Medication Adherence Scale (MMAS-8), Beliefs about Medication Questionnaire(BMQ), Richard Gray's scoring method of medication compliance confidence and willingness to take medication, and the changes of blood pressure.Results:Finally, 57 cases were included in the control group and 58 cases in the experimental group. There was no significant difference in the scores of medication compliance between the two groups before intervention( P>0.05). The scores of the control group and the experimental group were 5.110 ± 1.194, 6.160 ± 1.064 at 1 month after intervention and 5.044 ± 1.010, 6.306 ± 0.685 at 3 months after intervention, the differences were statistically significant ( t=4.98, 7.83, both P<0.05).There was no significant difference in medication belief score, medication compliance confidence score, willingness to take medication score, systolic blood pressure and diastolic blood pressure between the control group and the experimental group before intervention( P>0.05). One month after intervention, those index mentioned above were (2.561 ±2.605) points, (7.123 ± 1.310) points, (6.368 ± 1.234) points, (131.86 ± 13.13) mmHg(1 mmHg=0.133 kPa), (84.33 ± 7.05) mmHg in the control group, and (4.345 ± 3.006) points, (7.603 ± 1.388) points, (6.948 ± 1.527) points, (126.52 ± 12.44) mmHg, (83.95 ± 8.07) mmHg in the experimental group. Three months after intervention, those index mentioned above were (1.667 ± 2.149) points, (6.737 ± 1.218)points, (5.702 ± 1.362) points, (130.47 ± 13.77) mmHg, (84.25 ± 7.71) mmHg in the experimental group, and (4.879 ± 2.760) points, (7.793 ± 1.321) points, (7.207 ± 1.373) points, (125.71 ± 11.18) mmHg, (82.98 ±7.41) mmHg in the control group. One month and three months after intervention, the scores of medication belief and willingness to take medication in the experimental group were higher than those in the control group, and the systolic blood pressure was lower than that in the control group. Three months after interevention, medication compliance confidence was higher than that in the control group. The differences were statistically significant ( t values were -2.24-6.96, all P < 0.05). Repeated measurement analysis of variance showed that there were interactions between the group effect and time effect of medication compliance, medication belief, medication compliance confidence, willingness to take medication and systolic blood pressure ( F values were 12.81-26.17, all P<0.05). Conclusions:Solution-focused approach can significantly improve patients' medication adherence, beliefs about medication, medication compliance confidence, willingness to take medication, and effectively control blood pressure fluctuations.
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In recent years, clinical efficacy of pediatric kidney transplantation has been gradually enhanced with persistent progress of organ allocation policy, surgical technologies and perioperative management, etc. However, immunosuppressive management still plays a significant role in the long-term prognosis of pediatric kidney transplant recipients. Due to the disparity from adults in physiology, psychology, immune system and drug metabolism, immunosuppressive management in children should be delivered in a specific manner. Therefore, it is necessary to select appropriate immunosuppresants and formulate individualized immunosuppressive regimens according to the characteristics of pediatric kidney transplant recipients in clinical practice. In this article, the characteristics of immunosuppressive therapy, selection of immunosuppresants, glucocorticoid withdrawal, immune monitoring and medication compliance management of pediatric kidney transplant recipients were investigated, aiming to provide reference for optimizing immunosuppressive management and improving clinical prognosis of pediatric kidney transplant recipients.
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The authors introduced a pharmaceutical care mode by establishing a medication management platform(" Smart Pharmacists" platform), automatically and regularly sending personalized medication reminders for out-of-hospital patients. In virtue of the medication consultation service built on mobile internet technology, the hospital information system was seamlessly connected with the WeChat public account of the hospital, hence broadening pharmaceutical care. The " Smart Pharmacists" platform covered such six parts as medication reminder, medication record, voice broadcast, medication consultation, prescription query, and package insert inquiry. It serves as a reminder of taking medicine for patients out of the hospital and provides an accessible " pharmacist-patient interaction" service window, which will guarantee the safety and effectiveness of medication for out-of-hospital patients.
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OBJECTIVE：To study the current status and influencing factors of medication compliance in children with tic disorder（TD），and to provide reference for improving medication compliance in TD children. METHODS：The questionnaire was designed according to the protection motivation theory. The cross-sectional study was adopted to conduct questionnaire survey among TD children in West China Second Hospital of Sichuan University from Jan. 2018 to Dec. 2019. The structural equation model was established according to the theoretical assumptions，and the maximum likelihood method was used to estimate the model；multiple linear regression analysis was carried out for the factors with significant influence in the single factor analysis，and path analysis and intermediary effect test were carried out. RESULTS：A total of 317 patients with TD were included，the mean age was（8.38±2.54）years，and the mean course of disease was（3.19±2.46）years. Average medication compliance scores was （5.70±1.69），among which 15.1％ was low compliance，37.5％ moderate compliance，and 47.3％ high compliance. Multivariate linear regression analysis showed that comorbidities（β＝0.124，SE＝0.167，P＝0.011），education level of the main guardian（β＝ 0.236，SE＝0.110，P＜0.001），quality of life（β＝0.399，SE＝0.112，P＜0.001）and the types of drugs taken（β＝0.166，SE＝ 0.047，P＝0.001）were the factors affecting medication compliance of children with TD. Structural equation model analysis showed that severity（β＝0.295，95％CI：0.103-0.493），external return（β＝0.830，95％CI：0.662-1.002），self-efficacy（β＝0.200，95％CI： 0.057-0.353），susceptibility（β＝0.220，95％CI：0.084-0.352）and quality of life（β＝0.353，95％CI：0.211-0.500）had a direct positive impact on medication compliance. Quality of life mediated between external returns and compliance variables（intermediary effect accounted for 13.9％ of the total effect value）. CONCLUSIONS：Children with TD have low medication compliance. It is recommended that pediatricians in medical institutions at all levels to manage the medication compliance of patients with TD from the severity，susceptibility，external returns and self-efficacy，so as to improve patients and guardians’awareness of the severity and susceptibility of disease and medication non-adherence，weaken external returns and increase self-efficacy，and ultimately improve medication compliance of patients
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OBJECTIVE：To study influential factors for medication compliance of phosphate binder in patients with maintenance hemodialysis and the effects of pharmacist intervention ，and to improve medication compliance and the effects of disease control. METHODS ：The patients with maintenance hemodialysis who were treated in the blood purification center of our hospital from Jun. to Dec. ，2019 were selected for questionnaire survey. The questionnaires involved general information ， medication compliance of phosphate binder ，disease and medicine related knowledge ，social support ，self-efficacy. The t-test，χ2 test and multivariate Logistic regression analysis were used to analyze influential factors for medication compliance. The patients were randomly divided into pharmaceutical intervention group and non-intervention group. Intervention group were provided with pharmaceutical care for 3 months according to risk factors. Blood phosphorus level and medication compliance was compared between 2 groups. RESULTS ：Totally 298 patients completed the survey （effective recovery rate of 96.1％）. Among them ，163 patients（54.7％）had good adherence to phosphate binder ，while 135 patients（45.3％）had poor compliance. Results of single factor analysis showed that medication compliance of phosphate binder was closely associated with age ，dialysis duration ， parathyroid hormone levels ，total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ， social support ，self-efficacy（P＜0.05）. Results of multivariate Logistic regression analysis showed that total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ，social support and self-efficacy were the influential factors for medication compliance （P＜0.05 or P＜0.01）. Medication compliance ，disease control status ，disease and medicine related knowledge score ， social support and self-efficacy in pharmaceutical intervention group were significant improved ， blood phosphorus level was significant lower ，compared with non-intervention group （P＜0.05）. CONCLUSIONS ：Independent risk factors influencing medication compliance of phosphate binder include total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ，social support and self-efficacy. The patients with maintenance hemodialysis have poor compliance to phosphate binder. Pharmacists should take individualized and targeted intervention measures for the above risk factors，which can effectively improve the medication compliance and disease prognosis of patients.
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Objective To determine the effects of health education on medication compliance and bone mineral density of patients with osteoporosis in community. Methods A total of 123 patients with osteoporosis in A and B community(64 patients in control group and 59 patients in intervention group)received diverse health education and guidance. After a 2-year intervention, knowledge of osteoporosis, health behavior, medication compliance and bone mineral density change were compared between the two groups. Results In the intervention group, the proportions of correctly responding to the questions of osteoporosis were significantly improved before and after intervention(P < 0.05), except the questions of"exercise to what extent is better". Similarly, health behavior and medication compliance were also significantly improved in the intervention group(P < 0.05). In addition, knowledge of osteoporosis, most health behavior and medication compliance were better than those in the control group(P < 0.05). The difference in the bone mineral densitybetween the intervention group and the control group before and after intervention was 0.025±0.322 and -0.139±0.312(P < 0.05), respectively, showing significant differences(P < 0.05). Conclusion Health education for patients with osteoporosis may significantly improve health behavior, medication compliance, bone mineral density, and prognosis of osteoporosis.
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Background: Based on data from WHO, it is estimated that 70% of the 57 million deaths that occurred in the world in 2008 were caused by non-communicable diseases. The prevalence of cases of hypertension primary in the District of Wonosobo in the year 2016 as many as 43.30%. Hypertension patients must take medication during their lifetime to prevent rising blood pressure and complications. This research aims to find out the effect of hypertension management through an android application on the practice of adherence to taking medication in hypertensive patients in Wonosobo regency.Methods: This research is a quasi-experimental with a non-randomized pre-post-test control group design. The study is conducted in patients prolanis hypertension as much as 105 respondents were divided into a treatment group 53 respondents and group control of 52 respondents.Results: Results of the study showed the significant influence of the use of android application to practice obedience to drink medicine. Results of Mann Whitney U analysis showed the treatment group experienced a rise in the mean is higher than the group of control. Likewise, the results of the test Wilcoxon which compares the level of compliance before and after treatment obtained value significantly for both groups with a mean group of treatment is higher.Conclusions: The management of hypertension through an android application has proven to be more effective in improving the practice of adherence to taking medication hypertension patients who take part in the prolanis program in Wonosobo regen
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Objective@#To investigate the effect of early multi-dimensional cardiac rehabilitation (CR) nursing mode on patients after percutaneous coronary intervention (PCI).@*Methods@#From August 2017 to July 2018, 100 patients with coronary heart disease (CHD) underwent PCI in the Department of Cardiology, the Third Affiliated Hospital of Sun Yat-sen University were selected as subjects. According to the random number table, the patients were divided into control group and observation group, 50 in each group. The control group received routine CR nursing intervention, and the observation group was given early multi-dimensional CR nursing mode for intervention. All patients were followed up for 6 months. The incidence of major cardiovascular adverse events (MACE) was observed 1 month and 6 months of follow-up. Patients with somatization were evaluated on the 2nd day after PCI and in the first month of follow-up using the Somatic Self-rating Scale (SSS). In the first month and the 6th month of follow-up, patient compliance was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8).@*Results@#During the study period, 3 patients were detached from each group, and there were 47 patients in both groups who completed the study. The incidence of MACE in the control group in 1 month and 6 months was 8.51% (4/47) and 4.26% (2/47), respectively. The incidence of MACE in the observation group was 10.64% (5/47) and 4.26%, (2/47) respectively. There was no significant difference in the incidence of MACE between the two groups (χ2 value was 0.123, 0.000, P>0.05). In the first month of follow-up, the SSS scores of the control group (34.32±6.59) and the observation group (31.04±7.04) were lower than those of the second day after surgery (37.21±6.19, 37.43±7.29), and the difference was statistically significant (t value was 4.633, 2.660, P<0.05). The SSS scores of the observation group were lower than those of the control group, and the difference was statistically significant (t value was 2.330, P<0.05). In the first month of follow-up, there was no significant difference in MMAS-8 score between the two groups (P>0.05). In the 6th month of follow-up, the MMAS-8 score (5.72±0.62) in the control group was lower than the first month of follow-up (6.93±0.54), and the difference was statistically significant (t value was 10.028, P<0.05). The MMAS-8 score of the control group was lower than that of the observation group (6.89±0.58), and the difference was statistically significant (t value was 9.490, P<0.05). There was no significant difference in MMAS-8 score between the observation group in the first month of follow-up and the sixth month of follow-up (P>0.05).@*Conclusion@#Early multi-dimensional CR nursing mode has a limited effect on improving the incidence of MACE in patients after PCI, but it can effectively reduce the somatization symptoms of patients and maintain good medication compliance.
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OBJECTIVE：To eval uate the effect of pharmacists intervention on opioid treatment and management in outpatients with cancer pain under multidisciplinary team （MDT）mode. METHODS ：Totally 120 outpatients with cancer pain were selected from outpatient department of our hospital from Jan. 2016 to Dec. 2018，and divided into observation group and control group according to random number table method ，with 60 cases in each group. After 1 month follow-up ，patients in the control group were given opioid analgesics and routine intervention according to pain degree ，while patients in the observation group were given same treatment as control group and pharmacist intervention based on MDT. The pain condition ，medication compliance condition ， quality of life （QOL）score，the incidence of ADR and satisfaction degree were observed in 2 groups before and after intervention . RESULTS：Follow-up were completed in 2 groups. After intervention ，NRS scores of 2 groups were significantly lower than before intervention；the observation group was significantly lower than the control group ；medication compliance scores and QOL scores of 2 groups were significantly higher than before intervention ，the observation group was significantly higher than the control group at the same time . With the prolongation of treatment time ，the number of patients with mild pain and general medication compliance in 2 groups increased gradually ，and the observation group were significantly higher than the control group at the same time；the number of patients with moderate , severe pain and low medication compliance were significantly decreased gradually ， and the observation group was significantly lower than the control group at the same time. The number of patients with good medication compliance in the observation group was significantly higher than that in the same group before intervention and the control group at the same time （P＜0.05 or P＜0.01）. There was no significant difference in the incidence of ADR between 2 groups（P＞0.05）. The satisfaction of pain control results ，doctors’treatment and pharmacists follow-up in the observation group were significantly higher than control group （P＜0.05 or P＜0.01）. CONCLUSIONS ：Under MDT mode ，pharmacists participating in the management of opioid treatment for cancer pain outpatients can effectively relieve the pain ，and improve the medication compliance and quality of life .
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Introducción: En la práctica clínica es frecuente la pregunta acerca del porqué algunos pacientes con enfermedades crónicas no siguen las recomendaciones dadas por los profesionales de la salud, a pesar de la información que obtienen acerca de la enfermedad. Objetivo: Comprender como se construyen las posturas de autocuidado y su articulación con el significado de hipertensión arterial y la relación médico-paciente. Método: Estudio cualitativo, con diseño narrativo. Se analizaron espacios conversacionales con pacientes y profesionales de la salud. Resultados: La construcción de la experiencia en el espacio conversacional asistencial no tiene un punto de convergencia; ya que es parte de conversaciones unidireccionales centradas en la vivencia del médico frente al paciente y el diálogo de este último consigo mismo acerca de su enfermedad, experiencias que no logran transformaciones en el estilo de vida sostenibles en el tiempo, y que favorecen la emergencia de rótulos limitantes para la construcción de relaciones que posibiliten al paciente asumir su autocuidado. Conclusiones: El diálogo en la relación médico-paciente facilita el surgimiento de nuevos significados de la enfermedad y la activación de procesos, donde las personas pueden asumir la experiencia desde la responsabilidad y el autocuidado(AU)
Introduction: In clinical practice, the question is frequently posed about why some patients with chronic diseases do not follow the recommendations given by health professionals, despite the information that they obtain about the disease. Objective: To understand how self-care stances are constructed and their articulation with the meaning of arterial hypertension and the doctor-patient relationship. Method: Qualitative study, with narrative design. Conversational spaces were analyzed with patients and health professionals. Results: The construction of the experience in the conversational healthcare space does not have a convergence point, since it is part of unidirectional conversations centered on the experience of the physician in front of the patient and the latter's dialogue with himself/herself about his/her illness, experiences not leading to sustainable transformations in lifestyle over time and favoring the emergence of limiting labels for the construction of relationships that enable patients to assume their self-care. Conclusions: Dialogue in the doctor-patient relationship facilitates the emergence of new meanings of the disease and the activation of processes, by which people can assume the experience from responsibility and self-care(AU)
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Humans , Male , Female , Physician-Patient Relations/ethics , Self Care , Medication Adherence , Hypertension/epidemiologyABSTRACT
ABSTRACT Objective: To understand the feelings and behaviors of people being treated for Systemic Hypertension (SH) and Diabetes Mellitus (DM). Method: A qualitative study based on Grounded Theory and Symbolic Interactionism, with 27 participants in treatment for SH and DM followed up by the Family Health Strategy team. Open, axial and selective coding was performed, giving rise to three theoretical categories and the central category. Results: The daily life is explicit in the (lack of)care of the self with the chronic disease and feelings of sadness and anxiety are expressed as reasons for the lack of control of the disease. It points out that people take care of themselves because of fear of complications, reinforced the need for guidance on the use of medication and the empowerment of the chronic patient for self-care and care for the other. Final considerations: Knowing behaviors and feelings of people with SH and/or DM allows a professional performance beyond the chronic condition.
RESUMEN Objetivo: Comprender los sentimientos y comportamientos de personas en tratamiento de la hipertensión arterial sistémica (HAS) y la diabetes mellitus (DM). Método: Estudio cualitativo basado en la Teoría Fundamentada en los Datos y en el Interaccionismo Simbólico, con 27 participantes en tratamiento de la HAS y DM, y acompañados por el equipo Estrategia Salud de la Familia. Se procedió a la codificación abierta, axial y selectiva que originó las tres categorías teóricas y la categoría central. Resultados: El cotidiano de la vida está explícito en el (des) cuidado de sí con una enfermedad crónica. Los sentimientos de tristeza y ansiedad se expresan como motivos condicionantes para el descontrol de la enfermedad. Se señala que las personas se cuidan movidas por el miedo a las complicaciones. Se reforzó la necesidad de orientación sobre el uso de la medicación y del empoderamiento del paciente crónico para el autocuidado y cuidado del otro. Consideraciones finales: Conocer los comportamientos y sentimientos de las personas con HAS y/o DM permite una actuación profesional más allá de la condición crónica.
RESUMO Objetivo: Compreender os sentimentos e comportamentos de pessoas em tratamento para a Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus (DM). Método: Estudo qualitativo embasado na Teoria Fundamentada nos Dados e no Interacionismo Simbólico, com 27 participantes em tratamento para HAS e DM acompanhados pela equipe Estratégia Saúde da Família. Procedeu-se a codificação aberta, axial e seletiva que originaram três categorias teóricas e a categoria central. Resultados: O cotidiano de vida está explícito no (des)cuidado de si com a doença crônica e sentimentos de tristeza e ansiedade são expressos como motivos condicionantes para o descontrole da doença. Aponta que as pessoas se cuidam movidas pelo medo das complicações, reforçou a necessidade de orientação sobre o uso da medicação e do empoderamento do doente crônico para o autocuidado e cuidado do outro. Considerações finais: Conhecer comportamentos e sentimentos das pessoas com HAS e/ou DM permite uma atuação profissional além da condição crônica.
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Humans , Male , Female , Adult , Diabetes Mellitus/psychology , Medication Adherence/psychology , Hypertension/psychology , Brazil , Disease Management , Qualitative Research , Diabetes Complications/psychology , Diabetes Complications/drug therapy , Diabetes Mellitus/drug therapy , Grounded Theory , Self-Management/psychology , Hypertension/complications , Hypertension/drug therapyABSTRACT
OBJECTIVE: To explore the effect of integrated pharmaceutical intervention on medication compliance, risk factors control, and 6 months and 2 years prognosis in patients with coronary artery disease(CAD) after first percutaneous coronary intervention (PCI) in china. METHODS: 200 cases of patients diagnosed with CAD and underwent PCI successfully firstly in Zhoupu hospital during January 2015 to December were enrolled. The control group was given routine treatment and nursing care; pharmacist intervention group, on this basis, was given pharmaceutical intervention by pharmacists, including optimizing medication program, formulating pharmaceutical care plan, medication education, health education and regular pharmacists outpatient follow-up. The two groups were followed up for two years. Comparison of the Readmission(Readm) rate, incidence rate of major adverse cardiac events (MACEs), Readm expenses, awareness rate of commonly used two-grade preventive drugs for CAD, medication compliance and emotion management after 6 months and two years in the two groups. The control of risk factors in the two groups after 2 years were compared. RESULTS: After six months, the Readm rate, the incidence of MACEs and Readm expenses in pharmacist intervention group were lower than those in the control group, and the medication compliance was slightly higher than the control group (94.9% vs 87.4%); two years later, the standard rate of risk factors in pharmacist intervention group was significantly better than the control group(smoking3.1% vs. 12.6%, P=0.012; blood glucose standard rate79.6% vs. 62.1%, P=0.007; blood pressure standard rate74.5% vs. 53.7%, P=0.003; blood lipid standard rate84.7% vs. 57.9%, P<0.001); and the Readm rate, the incidence of MACEs and the cost of Readm were significantly lower than those of the control group after six months and two years. CONCLUSION: Pharmacists′ active pharmaceutical intervention on patients after PCI can effectively improve the medication compliance of the patients, reduce the postoperative risk factors and the incidence of MACEs, reduce medical expenses, improve the clinical prognosis, which were more significant when the follow-up time was longer.
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Objective@#To explore the comprehensive intervention mode of compliance with analgesics for home-based patients with moderate or severe cancer pain and to improve the medication compliance of home-based patients with cancer pain.@*Methods@#A self-designed questionnaire was designed to investigate the influencing factors of taking analgesics for home-based patients with moderate or severe cancer pain, 143 home-based patients with moderate to severe cancer pain were conveniently selected from Hospice Unit of Zhongnan Hospital of Wuhan University, from February 2016 to December 2017. To investigate the subjective, objective and psychological factors affecting patients' compliance with analgesics, comprehensive interventions such as health education, behavioral intervention, cognitive intervention and psychological counseling were carried out. Before and after the intervention, Morisky′s self-report questionnaire on medication compliance, pain digital grading (NRS score), and pain relief degree were assessed. Using self control design method and comparing the compliance of patients taking analgesics, number of complete compliance and non-compliance in patients taking analgesics and NRS score and pain relief before and after 8 weeks of intervention. Pain degree, pain relief degree and pain relief efficiency between patients with complete compliance and non-compliance after comprehensive intervention were evaluated.@*Results@#The main factors affecting patients' medication compliance with analgesics were fear of morphine addiction(16.37%, 37/226), single use of drugs and insufficient dosage (15.93%, 36/226), and fear of adverse drug reactions(13.72%, 31/226). The scores of NRS decrease in patients with different influencing factors were compared, with statistical difference (F=5.367, P=0.006). There were significant differences in the number and compliance of patients with complete compliance and non-compliance before and after 8-week-comprehensive intervention (χ2=25.583, P=0.000; t=-7.387, P=0.000). There were significant differences in pain degree, pain relief degree and pain relief efficiency between patients with complete compliance and non-compliance after 8-week-comprehensive intervention (χ2=76.572, 62.998, all P=0.000).@*Conclusions@#Comprehensive intervention on subjective, objective and psychological factors affecting the medication compliance of home-based patients with moderate or severe cancer pain can improve the medication compliance of patients to take analgesics and alleviate pain.
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OBJECTIVE： To introduce Pharmaceutical Care Network Europe （PCNE） classification system to develop medication therapy management （MTM）， and to investigate the application of PCNE classification system in solving drug-related problems （DRPs） in type 2 diabetic patients and the effect of it on clinical outcomes. METHODS： The patients with type 2 diabetes diagnosed in endocrinology department of our hospital from Jul. 10， 2018 to Oct. 31， 2018 were randomly divided into clinical pharmacist-led intervention （“physician-pharmacist-nurse” mode） group and control group receiving only traditional medical services （“physician-nurse” mode）. According to PCNE classification， the number of DRPs found in the pharmaceutical intervention group， the types of problems， causes， the types of interventions， acceptance for interventions and outcomes were analyzed and evaluated. Drug compliance （the highest score is 8） and HbA1c compliance （＜7％） were compared between 2 groups during hospitalization （or at the discharge） and 3 months after discharge. RESULTS： Totally 76 cases were included （40 cases in pharmaceutical intervention group and 36 cases in control group）. During hospitalization， 51 DRPs were found in the pharmaceutical intervention group， among which 42 problems were related to the effectiveness of treatment， mainly due to improper usage and dosage （23 problems）； the types of intervention was mainly aimed at the patient level （24 problems）. 38 problems received intervention （acceptance rate was 74.51％） and 32 problems （62.75％） were completely solved. Compared with those at admission， after following up for 3 months patients with low score （6 points） in the drug compliance of the pharmaceutical intervention group decreased from 26 to 8 （P＜0.000 1）， patients with medium score （6-8 points） increased from 10 to 22 （P＝0.006 2）， patients with high score （8 points） increased from 4 to 10， and drug compliance improved significantly， while there was no significant change in drug compliance in the control group. Compared with those at the discharge， after 3 months’ follow-up， the HbA1c compliance rate of the pharmaceutical intervention group increased from 25.00％ to 77.50％， and that of the control group increased from 25.00％ to 55.56％. There were statistical differences （P＜0.000 1）， and HbA1c compliance rate of the pharmaceutical intervention group was significantly higher than that of the control group. CONCLUSIONS： In the practice of MTM service， clinical pharmacists use PCNE classification system to collect， analyze， intervene， solve and evaluate DRPs systematically. The service mode can provide reference for standardizing pharmaceutical care mode.
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OBJECTIVE： To provide reference for improving medication compliance and therapeutic efficacy in community patients with type 2 diabetes mellitus （T2DM） in China. METHODS： The data was from the “Economic Study of Diabetic Medications in Patients with T2DM in China”， which was conducted by China Center for Health Economic Research of Peking University. Both univariate analysis and Logistic regression model were used for single factor analysis and multiple factor analysis of medication compliance. RESULTS： Totally 2 236 community T2DM patients were included. The rate of good medication compliance was estimated at as low as 23.48％. Monthly household income and duration of the disease had significant impact on medication compliance. Incidence of good the medication compliance for patients with monthly household income ≥6 000 yuan and during 3 000-＜6 000 yuan， compared to those with monthly household income ＜3 000 yuan， were 70.8％ [95％CI（0.532，0.944）] and 78.5％ [95％CI（0.614，1.004）] respectively. Incidence of good medication compliance for the patients with 5 to 10 years and ＞10 years of disease duration， compared to those with ＜5 years of disease duration， were 69.0％ [95％CI（0.542， 0.878）] and 59.1％ [95％CI（0.459， 0.760）] respectively. CONCLUSIONS： The medication compliance among community patients with T2DM in China was generally poor. Longer duration of the disease and higher monthly household income are associated with poorer medication adherence.
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OBJECTIVE： To provide reference for improving the treatment compliance and therapeutic effect of patients with type 2 diabetes mellitus （T2DM） in China. METHODS： The follow-up data was from the issue of Pharmacoeconomic Study of Diabetic Drugs in China， which was conducted by China Center for Health Economic Research （CCHER） of Peking University. Using follow-up endpoint HbA1c level as clinical output indicator， univariate analysis and multivariable regression analysis of binary and numerical variables were performed to evaluate the effect of treatment compliance on short-term clinical outcomes. RESULTS： Totally 2 236 community T2DM patients were included for the analysis. The patients with good and poor medication compliance accounted for 23.48％ and 76.52％； the patients with good and poor blood glucose monitoring compliance accounted for 7.02％ and 93.98％； 66.3％， 23.5％ and 10.2％ of the patients had good， medium and poor diet control compliance， respectively. Univariate analysis showed that there was a significant difference in the “good control” group of blood glucose and the “poor control” group of blood glucose in terms of patient age， body mass index， education level， duration of disease， exercise， and eating habits，etc （P＜0.05）. Similar results were obtained in the analysis of multiple Logistic regression and multivariate loglinear regression models， that is， blood glucose monitoring compliance and diet control compliance had significant positive effects on end-point HbA1c （P＜0.05）， but drug compliance had no significant effect （P＞0.05）. CONCLUSIONS： The treatment compliance among community patients with T2DM in China was generally poor. After controlling for other variables， patients’ treatment compliance has a positive effect on end-point HbA1c， especially better blood glucose monitoring compliance and diet control compliance contribute to blood glucose control， but medication compliance has no significantly effect.
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OBJECTIVE： To evaluate the effects of clinical pharmacist-led ischemic stroke management， and to provide reference for chronic disease management. METHODS： Totally 184 patients with ischemic stroke who were hospitalized in neurology department of the First Hospital of Hebei Medical University from May to August 2018 were included prospectively， and then divided into control group （92 cases） and intervention group （92 cases） by random number method. Control group did not receive clinical pharmacist intervention. In the intervention group， clinical pharmacists were the leader in the pharmaceutical care during the hospitalization， the medication education at discharge， and pharmacy follow-up after discharge. The rate of medication compliance （antiplatelet drugs， antihypertensive drugs， hypoglycemic drugs and lipid-lowering drugs） and the rate of secondary prevention and control indicators of ischemic stroke， such as blood pressure， blood glucose [glycated hemoglobin （HbA1c）] and blood lipid [low-density lipoprotein cholesterol （LDL-C）] were investigated between 2 groups at 6 months after discharge. The incidence of adverse drug reaction and the rate of rehospitalization were compared between 2 groups at 6 months after discharge. RESULTS： The number of patients in the intervention group and the control group was 84 and 82， respectively. At 6 months after discharge， the compliance rate of antiplatelet drugs in the intervention group was 96.43％， which was higher than 95.13％ of control group， but the difference was not statistically significant. The good compliance rates of antihypertensive drugs， hypoglycemic drugs and lipid-lowering drugs in the intervention group were 92.86％， 91.67％ and 77.38％， which were higher than 78.57％， 69.70％ and 60.98％ of control group， with statistical significance （P＜0.05）. The qualified rate of index of blood pressure was 89.29％ in intervention group， which was higher than 76.79％ of control group， but the difference was not statistically significant. The qualified rates of HbA1c and LDL-C in the intervention group were 80.56％ and 66.67％， which were higher than 57.58％ and 48.785 of control group， with statistical significance （P＜0.05）. The incidence of total adverse drug reactions in the intervention group was 15.48％， which was lower than 20.73％ of control group， but the difference was not statistically significant. The total rehospitalization rate in the intervention group was 7.14％， which was lower than 17.86％ of control group， the difference was statistically significant （P＜0.05）. CONCLUSIONS： The management of ischemic stroke patients with clinical pharmacists as the leading factor can improve the patient’s medication compliance， improve the qualified rate of secondary prevention and control indicators of ischemic stroke， and reduce the rate of rehospitalization.