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1.
健康教育对提高老年糖尿病患者服药依从性的研究   总被引:2,自引:0,他引:2  
目的:探讨健康教育对老年糖尿病患者服药依从性的影响.方法:将61例就诊的老年糖尿病患者随机分为干预组和对照组,对照组采取常规的定期随访,干预组在常规定期随访基础上开展针对性的全程糖尿病健康教育.通过半年的干预监测,分析两组患者的服药依从性.结果:61例老年糖尿病患者的服药依从率为44.26%.经过半年的健康教育,干预组的服药依从性明显优于对照组.结论:老年糖尿病患者服药依从性较差,健康教育可以提高其服药依从性.  相似文献
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This paper explores the role of mental health nurses in medication adherence and their perspective of what influences patients' medication non-adherence. Forty-eight mental health nurses with active patient caseloads completed a comprehensive questionnaire assessing a number of variables related to medications, including whom they felt was primarily responsible for monitoring the side-effects of medication, their knowledge skills and confidence in dealing with medication adherence and their prior education and training in medication adherence strategies. Lack of patient insight was endorsed as the strongest influence on patient non-adherence. Over 84% of nurses indicated they did not have any prior education or training in medication adherence strategies. Implications of the findings for education and training and nurses' roles in supporting medication adherence are discussed.  相似文献
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The purposes of this study were (1) to examine the psychometric properties of the Taiwanese version of the Morisky Medication Adherence Measure (MMAM), including its validity and reliability, (2) to investigate levels of analgesic regimen adherence, and (3) to explore the predictors of adherence to the analgesic regimen in a sample of Taiwanese cancer patients with pain. One hundred thirty-five patients receiving analgesics for cancer pain participated in this study. Instruments consisted of the Taiwanese version of the MMAM, the Barriers Questionnaire-Taiwan form, the Chinese version of the Brief Pain Inventory, the American Pain Society Outcome Questionnaire, Karnofsky Performance Status, and a demographic questionnaire. Analgesic use ratios were calculated. The Taiwanese version of the MMAM had good psychometric properties for measuring adherence with the analgesic regimens taken by Taiwanese cancer pain patients. Reliability was supported by good internal consistency Cronbach α and test-retest coefficients. Validity was corroborated by good known group validity, construct validity, and criterion-related validity. The majority of the patients (51%) showed low levels of medication adherence. The significant predictors for the medication adherence score were age, the Barriers Questionnaire score, and satisfaction with pain management by clinicians after entering pain severity, pain interference with daily life, age, gender, education, types of analgesics used, functional status, and satisfaction with pain management as independent variables. The model accounted for 63% of the variance in the medication adherence score. The Taiwanese version of the MMAM shows excellent reliability and validity. The use of this reliable, valid, simple, and easily administered tool can improve communication between patients and clinicians about use of analgesics and further improve the analgesic regimen adherence.  相似文献
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Non-adherence to medications is a prevalent and persistent healthcare problem, particularly for patients with a chronic disorder. Researchers have endeavoured to address poor adherence for the past five decades resulting in the accumulation of a vast body of literature. Despite the enormity of research conducted, interventions to date have neither been cost-effective nor predictably clinically effective in enhancing medication adherence. Though concerning, such contemporary information serves to refocus attention on the adequacy of knowledge regarding the factors influencing medication non-adherence.

Although little consensus exists regarding the optimal categorisation of these influencing factors, increasingly, the broad and ‘all encompassing’ categorisation of intentional and unintentional factors is being used to account for patient medication-taking behaviours and actions. An extensive review of the related literature provides the basis for a critical discussion on the value and comprehensiveness of this current classification in guiding future adherence research and consequent clinical interventions. An appraisal of this categorisation is important if decisions regarding interventions are not to be made in a vacuum of insufficient understanding, which would result in the continued ineffective use and distribution of valuable resources to combat non-adherence.  相似文献

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Time and timeliness are key issues in appraising and ensuring the clinical relevance of systematic reviews. Time considerations entering the systematic review process include the history of the clinical problem, disease, or treatment that is the target of the review, and the history of the research conducted to address it. These considerations guide: (i) formulation of the research problems and questions; (ii) setting of parameters for the search and retrieval of studies; (iii) determination of inclusion and exclusion criteria; (iv) appraisal of the clinical relevance of findings; (v) selection of the findings that will be synthesized; and (vi) interpretation of the results of that synthesis.  相似文献
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PURPOSE: To describe an approach to intervention, based on Motivational Interviewing (MI) and the Transtheoretical Model (TTM) of Change that allows the health care provider to support medication adherence in a client-centered fashion. DATA SOURCES: Review of selected research-based and theoretical articles on MI, TTM, and medication compliance issues. CONCLUSIONS: Adherence is a complex phenomenon that requires a personalized intervention. The response must focus on clients' readiness to adhere, their sense of self-efficacy in taking medicines in all circumstances, and their personal pros and cons related to adherence. IMPLICATIONS FOR PRACTICE: Adherence to complex medication regimens is important to long-term treatment of chronic diseases, such as HIV disease. Adherence in HIV is particularly critical to adequately suppress viral replication as well as to prevent opportunistic infections.  相似文献
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Background

The real-world clinical effectiveness of exogenous insulin is limited by nonadherence. Various insulin delivery systems have been developed to help improve adherence, with prefilled pens gaining popularity among adult Singaporeans with diabetes. However, adherence to insulin in people with diabetes in Singapore and most of Asia has not been studied.

Objectives

This study aimed to compare adherence to premixed insulin formulated in a prefilled pen versus a vial/syringe and to identify predictors of adherence in 955 patients managed at the outpatient clinics of the largest acute care hospital in Singapore.

Methods

In this retrospective longitudinal study, electronic medical and pharmacy refill records were used to determine adherence to insulin over 24 months, measured in terms of compliance and persistence. Compliance is expressed as the medication possession ratio (used as continuous and categorical variables), and persistence is reported as a dichotomous variable with a permissible refill gap of 30 days before discontinuation of therapy is considered. Multivariate linear or logistic regression analysis was used to identify predictors of adherence.

Results

Compared with prefilled pen users, vial/syringe users were older (mean [SD] age, 64.1 [10.6] vs 62.4 [11.9] years; P = 0.032), and more were undergoing polypharmacy (69.6% vs 54.1%; P < 0.001). The mean (SD) medication possession ratio was comparable in vial/syringe versus prefilled pen users (83.8% [26.9%] vs 86.0% [23.2%]; P = 0.266). Prefilled pen users were more persistent with therapy compared with vial/syringe users (odds ratio = 1.36; 95% CI, 1.01–1.86) after adjusting for sociodemographic and clinical covariates. Median time to discontinuation of therapy was comparable (vial/syringe vs prefilled pen: 409 vs 532 days; P = 0.076). Being managed by an endocrinologist and not receiving government subsidies were significant predictors of persistence.

Conclusions

Compared with other studies that found strong associations between adherence and insulin devices, the findings of this study suggest that persistence but not compliance varies by insulin device. The willingness to pay for health care, in addition to affordability, may affect insulin therapy adherence. Patients with uncontrolled diabetes due to suspected nonadherence may benefit from referral to a multidisciplinary care team comprising endocrinologists, diabetes nurse educators, dietitians, and allied health professionals. These findings are applicable to outpatients with similar demographic features managed at other acute care hospitals in Singapore. The impact of insulin devices on glycemic control needs to be investigated in future larger studies.  相似文献
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