"The medicine doesn't interest me at all." Beliefs, health behaviors, and medication adherence in peripheral arterial disease.

IF 2.4 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Anette Arbjerg Højen, Sara Jacobsen, Chalotte Winther Nicolajsen, Nikolaj Eldrup, Christian Nikolaj Petersen, Christian-Alexander Behrendt, Marie Dahl, Mette Søgaard
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引用次数: 0

Abstract

Background: Non-adherence to guideline-directed best medical therapies is prevalent in people with lower extremity peripheral arterial disease (PAD), constituting a significant challenge to effective treatment. Underlying drivers for non-adherence remain poorly understood. This study explored patients' health-related beliefs and behaviours regarding antithrombotic and lipid-lowering therapy to identify opportunities for improvement. Patients and methods: Using a qualitative design, we conducted semi-structured interviews with patients with symptomatic PAD based on a purposeful sampling strategy. Patients were recruited from four vascular surgery departments in Denmark between December 2022 and January 2024, excluding those with cognitive impairment or terminal illness. Data were analysed using framework analysis based on the six domains of the Health Belief Model (HBM): perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. Results: Sixteen patients participated (median age: 69 years, 38% women); 68.8% had intermittent claudication, 18.8% had chronic limb-threatening ischemia, and 12.5% had undergone major amputation. Seven patients were adherent, and nine were non-adherent to secondary preventive therapy. Patients expressed low perceived awareness of PAD severity and its cardiovascular implications. Their perception of PAD centred around leg pain and its impact on everyday life, limiting their understanding of the benefits of secondary preventive therapies. Patients lacked knowledge about treatment goals and did not link secondary preventive therapy with PAD. Adherence barriers included inadequate understanding of PAD's chronic progressive nature, concerns about side-effects, prescription confusion, and financial constraints. Internal adherence triggers included fear of recurring pain, complications, and early death. External cues to action included a trusting patient-provider relationship and receiving comprehensive, understandable information. Conclusions: This study highlights the multifaceted challenges hindering adherence to antithrombotic and lipid-lowering therapies. Addressing the limited disease awareness and the expressed need for patient-centred communication delivered in a trusting patient-provider relationship could serve as starting point for future strategies to improve adherence.

“这种药我一点也不感兴趣。”外周动脉疾病的信念、健康行为和药物依从性
背景:不遵守指南指导的最佳药物治疗在下肢外周动脉疾病(PAD)患者中很普遍,这对有效治疗构成了重大挑战。不遵医嘱的潜在驱动因素仍然知之甚少。本研究探讨了患者在抗血栓和降脂治疗方面的健康相关信念和行为,以确定改善的机会。患者和方法:采用定性设计,我们基于有目的的抽样策略对有症状的PAD患者进行了半结构化访谈。在2022年12月至2024年1月期间,从丹麦的四个血管外科部门招募了患者,不包括认知障碍或绝症患者。数据采用基于健康信念模型(HBM)六个领域的框架分析:感知易感性、严重程度、益处、障碍、行动线索和自我效能感。结果:16例患者参与(中位年龄:69岁,女性38%);68.8%患有间歇性跛行,18.8%患有慢性肢体缺血,12.5%经历过大面积截肢。7例患者坚持二级预防治疗,9例未坚持二级预防治疗。患者对PAD严重程度及其心血管影响的认知程度较低。他们对PAD的认知主要集中在腿部疼痛及其对日常生活的影响上,这限制了他们对二级预防治疗益处的理解。患者缺乏对治疗目标的了解,没有将二级预防治疗与PAD联系起来。坚持治疗的障碍包括对PAD的慢性进行性认识不足、对副作用的担忧、处方混乱和财政限制。内部依从性触发因素包括对复发性疼痛、并发症和过早死亡的恐惧。采取行动的外部线索包括信任医患关系和接受全面、可理解的信息。结论:这项研究强调了阻碍抗血栓和降脂治疗依从性的多方面挑战。解决有限的疾病意识和在信任的患者-提供者关系中提供以患者为中心的沟通的明确需求,可以作为未来改善依从性战略的起点。
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来源期刊
CiteScore
3.90
自引率
11.10%
发文量
61
审稿时长
1 months
期刊介绍: Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology. The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation. Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.
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