背景:家庭用药管理研究不足,包括在常规和异常情况下影响依从性策略发展和有效性的因素。老年人是一个特别重要的研究人群,因为服用药物的可能性更大,同时渴望“年龄到位”。“
目的:本访谈研究旨在了解老年人如何制定药物管理策略,确定这些策略何时以及为什么成功或失败,了解更多关于老年人如何看待他们的药物,并探索提高药物依从性的干预措施。
方法:本研究采用定性,半结构化面试设计,以引出老年人家庭药物管理的经验。总的来说,招募了22名年龄≥50岁服用1至3种处方药的参与者并进行了访谈。记录了采访回复,主题,通过回顾记录并确定重复模式和主题进行定性分析.反应被系统地编码,这不仅有助于识别这些主题,还允许我们量化行为和感知的普遍性,提供对药物管理和药物依从性的有力理解。
结果:参与者报告自己制定家庭用药管理策略,没有参与者接受医疗保健提供者的指导,59%(13/22)的参与者使用反复试验。研究参与者制定的策略都是独特的,通常包括处方药和维生素或补充剂。医生的处方或推荐与他们独立选择之间没有界限。参与者通过化学名称(10/22,45%)考虑他们的药物,通过药丸的出现(8/22,36%),根据药物的目的(2/22,9%),或按药物的通用名称(2/22,9%)。药丸病例(17/22,77%)比处方瓶(5/22,23%)更受欢迎,用于存储每日药物。大多数参与者(19/22,86%)将药丸盒或处方瓶存放在家中可见的位置,那些使用药丸的人在他们的补充程序上有所不同。参与者使用≥2个常规或对象作为触发因素服用药物。不坚持与他们的日常工作中断有关。最后,只有14%(3/22)的参与者使用了基于时间的提醒或警报,并且没有参与者使用药物依从性设备或应用程序。
结论:我们研究的参与者在家庭用药管理策略方面差异很大,并制定了独特的常规程序,以记住服用药物以及补充药丸。为了减少在制定战略时的试错,医师和药剂师有机会向老年人提供依从性指导.为了尽量减少干扰对依从性的影响,有机会开发更持久的策略,并设计辅助药物依从性,利用既定的日常生活。
BACKGROUND: Home medication management has been insufficiently studied, including the factors that impact the development and effectiveness of adherence strategies under both routine and anomalous circumstances. Older adults are a particularly important population to study due to the greater likelihood of taking medication in combination with the desire to \"age in place.\"
OBJECTIVE: This
interview study aims to understand how older adults develop medication management strategies, identify when and why such strategies succeed or fail, learn more about how older adults think about their medication, and explore interventions that increase medication adherence.
METHODS: This study used a qualitative, semistructured
interview design to elicit older adults\' experiences with home medication management. Overall, 22 participants aged ≥50 years taking 1 to 3 prescription medications were recruited and interviewed.
Interview responses were recorded, and thematic, qualitative analysis was performed by reviewing recordings and identifying recurring patterns and themes. Responses were systematically coded, which not only facilitated the identification of these themes but also allowed us to quantify the prevalence of behaviors and perceptions, providing a robust understanding of medication management and medication adherence.
RESULTS: Participants reported developing home medication management strategies on their own, with none of the participants receiving guidance from health care providers and 59% (13/22) of the participants using trial and error. The strategies developed by study participants were all unique and generally encompassed prescription medication and vitamins or supplements, with no demarcation between what was prescribed or recommended by a physician and what they selected independently. Participants thought about their medications by their chemical name (10/22, 45%), by the appearance of the pill (8/22, 36%), by the medication\'s purpose (2/22, 9%), or by the medication\'s generic name (2/22, 9%). Pill cases (17/22, 77%) were more popular than prescription bottles (5/22, 23%) for storage of daily medication. Most participants (19/22, 86%) stored their pill cases or prescription bottles in visible locations in the home, and those using pill cases varied in their refill routines. Participants used ≥2 routines or objects as triggers to take their medication. Nonadherence was associated with a disruption to their routine. Finally, only 14% (3/22) of the participants used a time-based reminder or alarm, and none of the participants used a medication adherence device or app.
CONCLUSIONS: Participants in our study varied considerably in their home medication management strategies and developed unique routines to remember to take their medication as well as to refill their pill cases. To reduce trial and error in establishing a strategy, there are opportunities for physicians and pharmacists to provide adherence guidance to older adults. To minimize the impact of disruptions on adherence, there are opportunities to develop more durable strategies and to design aids to medication adherence that leverage established daily routines.