Abstract：
BACKGROUND: Although much is known about cardiovascular patients\' medication adherence, the extent to which clinicians perceive non-adherence as a barrier in clinical practice is little explored. Objective To evaluate knowledge and awareness about potential barriers to medication adherence, and to evaluate strategies used in clinical practice by Portuguese clinicians on how to foster medication adherence of patients undergoing secondary cardiovascular prevention. Setting Nominal Group Technique (NGT) at the University of Lisbon; online survey addressed to physicians working in primary and secondary care in Portugal. Method A narrative literature review was conducted in Pubmed to identify studies describing interventions targeted at physicians to manage medication adherence. The NGT included 12 allied healthcare professionals with recognized expertise in medication adherence and was organised in four phases, resulting in survey development. The survey was used in a cross-sectional national study where clinicians reported their knowledge and perceptions about patients\' medication adherence and their daily practice. Main outcome measures Knowledge and awareness about barriers to medication adherence; and practice patterns. Results A total of 296 papers were identified, 26 of which were included. Four main topics were selected to be used in the NGT: adherence determinants, detecting non-adherence, fostering adherence, and educating physicians. NGT resulted in a survey, reaching 451 physicians, mostly practicing in primary care. Most had specific education on medication adherence and considered patient interviews and prescription records the most useful assessment methods. Nonetheless, many recognised often using clinical judgement to evaluate adherence in practice. Barriers to medication adherence were perceived to occur often during implementation. Most perceived reasons for uncontrolled hypertension were non-adherence to lifestyle recommendations and to medication. Less than half the physicians asked their patients if medication was taken. More useful enabling strategies included reducing daily doses, reviewing therapeutic options and motivational interventions. Conclusions Clinicians seem well informed about the importance of medication adherence and aware of problems encountered in practice. Limited time during medical appointment may be a barrier for better patient support.
摘要：
背景：尽管人们对心血管患者的药物依从性了解很多，临床医生认为非依从性在临床实践中是一个障碍的程度还很少被探讨.目的评估对药物依从性潜在障碍的知识和认识，并评估葡萄牙临床医生在临床实践中使用的策略，以提高接受二级心血管预防的患者的药物依从性。在里斯本大学设置名义组技术（NGT）；在线调查针对在葡萄牙的初级和二级保健工作的医生。方法在Pubmed中进行了叙述性文献综述，以确定描述针对医生管理药物依从性的干预措施的研究。NGT包括12名在药物依从性方面具有公认专业知识的专职医疗专业人员，并分四个阶段进行组织。导致调查发展。这项调查被用于一项全国横断面研究，临床医生报告了他们对患者服药依从性和日常实践的知识和看法。主要结果指标对药物依从性障碍的知识和认识；和实践模式。结果共鉴定出296篇论文,其中包括26个。在NGT中选择了四个主要主题：依从性决定因素，检测不依从性，促进坚持，和教育医生。NGT导致了一项调查，达到451名医生，主要是在初级保健中执业。大多数人对药物依从性进行了专门的教育，并认为患者访谈和处方记录是最有用的评估方法。尽管如此，许多人认识到经常使用临床判断来评估实践中的依从性。在实施过程中，人们认为药物依从性的障碍经常发生。不受控制的高血压的大多数感知原因是不遵守生活方式建议和药物治疗。不到一半的医生询问患者是否服用药物。更有用的启用策略包括减少每日剂量，回顾治疗方案和动机干预措施。结论临床医生似乎很了解药物依从性的重要性，并意识到实践中遇到的问题。医疗预约期间的有限时间可能是更好的患者支持的障碍。
