Abstract：
OBJECTIVE: 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.
METHODS: 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).
METHODS: Norway (2022-2023).
METHODS: 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs).
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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).
METHODS: Norway (2022-2023).
METHODS: 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs).
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：这项研究的主要目的是双重的：调查心力衰竭（HF）患者在家中告诉医生他们的服药依从性的信息。以及在建议进行药物和解的咨询中提供此类信息的频率。为了实现这些目标，我们开发了一个分析来识别，定义，并计算（1）患者话语，包括临床相互作用中的药物依从性披露（MADICI），(2)MADICI，包括不遵守的危险信号，和（3）由患者在没有医生提示的情况下发起的MADICI。
方法：基于探索性相互作用的观察性队列研究。真正的医患咨询的感应式微观分析，每个患者在三个时间点录制的音频：（1）在医院的第一次病房就诊，(2)出院访视,和（3）对全科医生（GP）的随访。
方法：挪威（2022-2023年）。
方法：25名HF患者（65岁以上）及其主治医生（23名医院医生，25GPs）。
结果：我们通过两个标准认可MADICI：（1）它们是关于在家中使用的处方药，并且（2）它们涉及患者的行动，经验,或关于药物的立场。使用这些标准，我们确定了25例患者轨迹中的427例MADICIs：首次病房就诊时143例（34％）（min-max=0-35，中位数=3），57（13％）在出院访视（最小-最大=0-8，中位数=2），GP就诊时227例（53%）（min-max=2-24，中位数=7）。在427名候选人中，235（55％）包括不遵守的危险信号。布美他尼和阿托伐他汀最常被提及有问题。427名MADICI中的146名患者（34%）开始服用。在235个“红旗马德里”中，101（43%）由患者发起。
结论：自我管理老年HF患者公开了他们在家中使用药物的信息，通常包括不遵守的危险信号。披露表明依从性问题的信息的患者倾向于这样做。此类披露为医生提供了评估和支持患者在家服药依从性的机会。
方法：基于探索性相互作用的观察性队列研究。真正的医患咨询的感应式微观分析，每个患者在三个时间点录制的音频：（1）在医院的第一次病房就诊，(2)出院访视,和（3）对全科医生（GP）的随访。
方法：挪威（2022-2023年）。
方法：25名HF患者（65岁以上）及其主治医生（23名医院医生，25GPs）。
结果：我们通过两个标准认可MADICI：（1）它们是关于在家中使用的处方药，并且（2）它们涉及患者的行动，经验,或关于药物的立场。使用这些标准，我们确定了25例患者轨迹中的427例MADICIs：首次病房就诊时143例（34％）（min-max=0-35，中位数=3），57（13％）在出院访视（最小-最大=0-8，中位数=2），GP就诊时227例（53%）（min-max=2-24，中位数=7）。在427名候选人中，235（55％）包括不遵守的危险信号。布美他尼和阿托伐他汀最常被提及有问题。427名MADICI中的146名患者（34%）开始服用。在235个“红旗马德里”中，101（43%）由患者发起。
结论：自我管理老年HF患者公开了他们在家中使用药物的信息，通常包括不遵守的危险信号。披露表明依从性问题的信息的患者倾向于这样做。此类披露为医生提供了评估和支持患者在家服药依从性的机会。
