居家老年多病共存患者多重用药体验的质性研究

Multiple Medication Experience of Elderly Patients with Multimobidity at Home:a Qualitative Study

背景近年来老年多病共存患者多重用药问题突出,严重降低其生活质量。重视患者用药体验是减轻其用药问题的关键要素,研究居家老年多病共存患者多重用药体验可为解决其用药问题提供新视角。目的探讨居家老年多病共存患者多重用药体验及影响因素,为制定有效干预方案提供依据。方法采用方便抽样法从郑州市2个城区(高新区、金水区)选取3家社区卫生服务中心,每家社区卫生服务中心分别选取4~5例老年多病共存多重用药患者,最终共纳入14例患者为研究对象。采用半结构深度访谈法,于2019年5-8月对14例患者进行访谈。访谈内容主要包括:患者多重用药时,对生活的影响、目前药物管理的现状、存在的问题及其如何解决、希望在多重用药过程中通过何种方式得到何种帮助。对访谈资料进行整理分析,并提炼主题。结果通过对访谈资料整理分析,共提炼出6个主题:用药相关知识需求较大、经济压力沉重、用药管理实践欠佳、情绪认知改变、日常生活障碍、家庭支持不足。结论居家老年多病共存患者多重用药体验不容乐观,各级医疗卫生机构应关注这一现象。应加强慢性病常用药物的健康宣教,提升全民药物素养;规范临床药师和全科医生培训管理机制,完善慢性病医保制度;重视患者心理感受,强化家庭和社会支持作用,从而改善患者用药体验和生活质量。

Background The polypharmacy in elderly patients with multimobidity has become a serious problem in recent years,which greatly reduces patient's quality of life.Paying attention to patient's medication experience is the key factor to alleviate their medication problems.The study of multiple medication experience of elderly patients with multimobidity at home can provide a new perspective to solve their medication problems.Objective To explore the multiple medication experience of elderly patients with multimobidity at home and its influencing factors,in order to provide basis for the formulation of effective intervention programs.Methods Three community health service centers were selected from two urban districts(Gaoxin District and Jinshui District)of Zhengzhou City by convenient sampling method.Each community health service center selected four to five elderly patients with multimobidity and polypharmacy,and finally 14 patients were included in the study.Semistructured and in-depth interviews were conducted to interview 14 participants from May to August in 2019.The main contents of the interview included the effect of polypharmacy on patient's life,the current situation and problems of medication management and how to solve them,and what kind of help was hoped for in the course of polypharmacy.The interview data were sorted out and analyzed to refine the main topics.Results Through the analysis of the interview data,six themes were extracted:a large demand of knowledge related to medication,heavy economic pressure,poor practice of medication management,changes in emotional cognition,obstacles to daily life,and the lack of family support.Conclusion The multiple medication experience of the elderly patients with multimobidity at home is not optimistic,and health care institutions at all levels should pay attention to this phenomenon.The health education of drugs commonly used for chronic diseases should be strengthened to improve the level of drug literacy among the whole people.The training and management mechanism of clinical pharmacists and general practitioners should be standardized to improve the medical insurance system for chronic diseases.Attention should be paid to patient's psychological feelings so as to strengthen the role of family and social support,in order to improve patient's medication experience and quality of life.