心血管疾病一级和二级预防患者用药习惯的价值观与偏好:一项探索式混合方法研究

Values and Preferences of Pharmacotherapy in Patients with Primary and Secondary Prevention of Atherosclerotic Cardiovascular Disease:a Mixed-methods Study

背景药物治疗是心血管疾病一级和二级预防的重要基石,但患者对药物治疗的价值观及偏好尚不清楚。目的探索心血管疾病一级和二级预防患者用药习惯的价值观及偏好,有助于减轻药物治疗负担,以提高患者用药的依从性。方法本研究为探索性序列设计混合方法研究。首先采用分层目的抽样法,于2021年11月—2022年1月在四川大学华西医院和成都市武侯区玉林社区卫生服务中心筛选符合心血管疾病一级和二级预防标准的患者作为本研究的访谈对象。通过焦点小组访谈法收集定性数据,了解受访者用药相关的行为、价值观与偏好。并应用MAXQDA 2020对访谈内容进行编码、归类,用Colaizzi七步分析法进一步进行整理、分析,并提炼访谈主题。完成定性研究后,结合访谈归纳的主题,再设计定量问卷。其次采用方便抽样法,于2022年11月—2023年2月在四川大学华西医院心血管内科、内分泌科、肾脏内科和神经内科门诊,以及成都市武侯区玉林社区卫生服务中心选取符合心血管疾病一级及二级预防标准的患者作为调查对象,签署知情同意书后进一步就受访者用药相关的价值观与偏好的量化情况做出分析。结果定性研究共纳入21例受访者进行焦点小组访谈,共提炼出4个主题:(1)对药物的认知及行为;(2)用药的阻碍因素;(3)用药的促进因素;(4)对医疗服务的需求。定量研究共回收有效问卷186份(回收率93.5%),结果提示漏服药的行为普遍存在,并进一步证实定性研究中社会污名化和用药负担的存在。尽管用药的偏好具有高度异质性,调查对象普遍更倾向于更少的用药种类和频率,同时不倾向于使用注射制剂。结论在心血管疾病一级和二级预防临床实践中,可考虑增加复方制剂的使用,同时将药物治疗方案与患者日常生活及工作整合,以减少用药负担。同时还应积极干预患者对疾病及药物的错误认知及行为,提升患者的用药依从性。

Background Pharmacotherapy is the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases(ASCVD),but the values and preferences of community patients for pharmacotherapy remain unclear.Objective To understand the values and preferences surrounding pharmacotherapy among community patients at risk of or undergoing treatment for ASCVD,which would help clarify the individualized treatment burden and provide patientcentered clinical practice.Methods This study employed a sequential exploratory mixed-methods design.Firstly,we recruited eligible patients in West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District,Chengdu City from November 2021 to January 2022.for a focus group discussion,aiming to collect qualitative insights into their experience,values,and preferences for medication use.The software MAXQDA 2020 was used to support qualitative data analysis,and Colaizzi's seven-step approach was further used to identify themes.After completing the qualitative phase,a questionnaire was designed based on the emergent themes to further quantitatively analyze the values and preferences regarding pharmacotherapy.Results Four themes emerged from the qualitative data,including knowledge and use of medications,barriers of medication use,facilitators of medication use,and need for medical services.A total of 186 valid questionnaires were collected in the quantitative study(response rate of 93.5%).The quantitative data showed a commonality in missed dose and confirmed the existence of social stigma and treatment burden in this group of participants.Although preferences in medication use were highly heterogeneous,participants generally preferred taking fewer medications with less frequency,and were less likely to use injectable medications.Conclusion The study suggests that it may be appropriate to increase the use of compound preparations,and make treatment plans in accordance with patients'daily lives and work to reduce the treatment burden of pharmacotherapy.In addition,we should be active in managing the misconceptions and improper practices in pharmacotherapy in order to improve patients'medication adherence.