动机性访谈对青光眼患者随访依从性及自我管理行为的影响

目的：探讨动机性访谈对青光眼患者随访依从性及自我管理能力的影响。方法：选取本院2017年2月-2018年4月收治的青光眼患者100例为研究对象，按照随机数字表法分为例数均等的2组，对照组给予常规健康教育，观察组在常规健康教育基础上进行动机性访谈，比较两组出院后1周、1、3、6个月时的随访依从性，观察干预前后两组自我管理行为改变情况。结果:出院后1周时，观察组随访依从率为100%，对照组为94.0%，两组比较差异无统计学意义（P>0.05）；出院后1、3、6个月时，观察组随访依从率均在90%以上，对照组明显低于观察组（P<0.05）；干预后观察组自我管理行为问卷各项得分及总分明显高于干预前且显著高于对照组（P<0.05）。结论：动机性访谈可显著提高青光眼患者的随访依从性及自我管理能力，有较高的临床价值。     

延续护理干预对出院冠心病患者健康行为依从性及预后的影响

目的:探讨延续护理干预对出院冠心病患者健康行为依从性及预后的影响。方法:将104例出院冠心病患者随机分成观察组及对照组,两组均在住院期间实施常规护理及出院指导,观察组在此基础上实施延续护理干预,随访观察6个月,采取健康行为依从性调查问卷评价两组患者健康行为依从性,检测血压、血脂水平,观察心脏不良事件发生率。结果:出院6个月后观察组在遵医嘱用药、合理饮食、适度运动等健康行为依从性较对照组明显提高(P0.01);两组患者出院6个月后血压、血脂水平均较出院时明显下降(P0.05),观察组血压、血脂水平明显低于对照组(P0.05);两组随访6个月内心脏不良事件发生率分别为3.85%、13.46%,两组比较差异无统计学意义(P0.05)。结论:对出院冠心病患者实施延续护理干预,有助于提高健康行为依从性,改善血脂、血压水平,有助于控制心脏不良事件的发生,从而改善预后。     

强化出院指导提高心力衰竭患者生活质量及服药依从性的研究

目的探讨对心力衰竭患者进行强化出院指导对提高其生活质量及依从性的效果。方法将87例心力衰竭患者随机分成干预组（46例）和对照组（41例）。对照组采用常规出院指导；干预组进行强化出院指导，即由经过培训的护理人员在患者出院后对患者进行有计划、有组织的健康教育和指导。采用明尼苏达心力衰竭患者生活质量量表（MLHF）和6min步行试验对2组患者的生活质量情况进行评价，并比较其服药依从性、生活方式改变情况。结果随访6个月后，干预组与对照组健康相关生活质量及6min步行距离比较差异均有统计学意义（P〈0．01）。干预组服药依从性高于对照组，差异有统计学意义（P〈0．05）。结论对心力衰竭患者强化出院指导，有助于改善患者的生活质量及依从性。     

健康教育对高脂血症患者改变不良生活方式服药依从性的影响

目的探讨健康教育对高脂血症患者改变不良生活方式服药依从性的影响。方法将112例入院治疗的高脂血症患者随机分为健康教育联合用降脂药组（健康教育组）及单用降脂药治疗组（对照组）各56例，分别于入院和出院时进行相关知识及治疗问卷（ITAQ）及服药依从性评定，并对两组临床疗效痊愈＋显著进步以上的患者进行为期两年的随访。结果入院时两组间比较，差异无显著性（P〉0．05），但出院时健康教育组明显高于对照组（P〈0．01）。入院时服药依从性两组间比较无显著性（P〉0．05），但出院时健康教育组服药依从性改善明显优于对照组（P〈0．01），两年内，健康教育组显著改变其不良生活方式。结论健康教育有助于高脂血症患者的治疗。     

心力衰竭出院患者的预后状况及相关影响因素的研究

研究心力衰竭出院患者的预后状况及相关影响因素。选取80例心力衰竭患者进行研究,分析出院后半年内服药依从性、生活行为方式变化等。患者入院后服药依从性、生活行为方式均显著优于入院前,差异有统计学意义(P<0.05);再次住院,16例(20.0%),死亡2例(12.5%)。患者入院前生活行为方式、服药依从率均较差,出院半年后服药、生活行为方式依从率得到良好改善。     

延续护理对冠心病介入术后患者生存质量、心绞痛症状及服药依从性影响研究

目的探讨延续护理对冠心病介入治疗患者出院后生存质量、心绞痛症状及服药依从性影响。 方法纳入2016年1月至2017年1月在南京医科大学第一附属医院老年心脏科就诊并收治入院的90例冠心病介入治疗患者为研究对象，按照随机数字表分为对照组和观察组，各45例。两组患者住院期间接受相同治疗措施，对照组接受常规护理，观察组在对照组护理措施基础上接受出院后延续护理，出院后6个月对患者进行问卷调查，观察两组出院6个月后生存质量、心绞痛症状及服药依从性之间的差异。结果出院时，两组患者CCQQ和SAQ问卷评分差异无统计学意义（P＞0.05）。观察组接受6个月出院延续护理后，CCQQ问卷中一般生活功能、社会心理功能等6项得分及SAQ问卷中躯体活动受限程度、心绞痛稳定状态等5项得分显著高于对照组（P＜0.05）。且经过6个月延续护理后，观察组服药依从性占比为75.56%，高于对照组的5333%（P＜0.05）。 结论延续护理可显著改善冠心病介入治疗患者出院后生存质量和心绞痛症状并提高患者服药依从性。     

系统化健康教育对急性胰腺炎治疗依从性及生活质量的影响

目的：探讨系统化健康教育对急性胰腺炎患者治疗依从性及生活质量的影响。方法：50例研究对象选自2017年1月~2020年12月收治的急性胰腺炎患者,依照随机数字表法分为观察组（25例）和对照组（25例）。对照组给予常规护理干预,观察组在对照组的基础上给予系统化健康教育,两组均干预至出院,并随访3个月。比较两组干预后的效果、腹胀腹痛缓解时间、肠鸣音恢复时间、排气排便时间、依从性及干预后3个月的生活质量。结果：观察组总依从率（96.00%）、总有效率（92.00%）均高于对照组（76.00%、68.00%）;干预后,观察组腹胀腹痛缓解时间、肠鸣音恢复时间、排气排便时间均短于对照组;干预后3个月,观察组生活质量量表各项评分均高于对照组（P＜0.05）。结论：系统化健康教育可以更有效地提高急性胰腺炎患者的干预效果及依从性,改善临床症状,促进康复,同时还可以提高患者的生活质量。     

家庭护理干预对急性心肌梗死患者康复期生活质量的影响

目的 探讨家庭护理干预对急性心肌梗死患者康复期生活质量的影响.方法 将210例急性心肌梗死患者随机分为两组,干预组患者实施家庭护理干预,然后应用中文版SF-36健康调查量表测评患者的生活质量.结果 半年后干预组生活质量改善明显,与对照组比较六个维度差异有显著性意义（P ＜0.05或P＜0.01）;一年后干预组各维度得分接近正常人的生活质量,而对照组改变不明显;两组患者在心脏事件发生情况、再住院人次数、依从性、相关指标等项目的比较差异有显著性意义（P＜0.05或P＜0.01）.结论 改变病人不良的生活习惯,提高治疗依从性,可有效改善冠心病患者的康复效果,从而提高病人的生活质量.     

心理疏导对冠心病抑郁患者康复运动依从性的作用

目的：探讨心理疏导对冠心病患者康复运动依从性的作用。方法：冠心病抑郁患者80例，随机分为干预组与对照组各40例，均给予药物治疗及健康教育，干预组同时增加心理疏导。结果：经过1年的观察后，2组抑郁自评量表（SDS）评分与观察前比较均有明显降低（P〈0．01），与对照组比较，干预组下降更明显；康复运动的依从率干预组患者明显高于对照组（均P＜0．01）。结论：配合心理疏导疗法能有效改善冠心病患者心理状况，提高患者的康复依从性。     

健康信念模式对冠心病患者二级预防依从性的影响

目的探讨健康信念模式对冠心病患者二级预防依从性的影响。方法选取2015年1月~2016年10月在我院诊治的40例冠心病患者实施常规护理+健康信念模式作为观察组,2013年1月~2014年12月仅实施常规护理的40例冠心病患者作为对照组,通过比较2组患者服药依从性与健康生活方式的改变程度评价二级预防的依从性。结果干预前2组患者健康生活方式评分差异无统计学意义(P0.05),干预后观察组健康生活方式评分(89.27±0.79)分明显高于对照组(70.45±0.63)分,差异均有统计学意义(P0.05);干预6月后,观察组服药依从性92.5%明显高于对照组57.5%,差异有统计学意义(P0.05)。结论健康信念模式可以提高冠心病患者服药依从性,树立患者健康生活方式,从而提高冠心病患者二级预防的依从性。     

Understanding the influence of urban- or rural-living on cardiac patients’ decisions about diet and physical activity: Descriptive decision modeling

Background

It is challenging to assist people to attend to risk factors for coronary artery disease (CAD). There is potential for cultural elements associated with place of residence (i.e., urban- or rural-living) to have an effect on peoples’ decision-making about managing CAD risk.

Aim

To better understand patient's decision-making processes regarding having a heart-healthy diet and engaging in regular physical activity (major CAD risk factors), and the potential influence of urban- or rural-living.

Methods

Based on a previous series of qualitative interviews with 42 cardiac patients (21 urban-living, 21 rural-living), hierarchical decision-models regarding eating a heart-healthy diet and engaging in regular physical activity were developed, and a survey based on the decision-models generated. The models were then tested for ‘fit’ with another group of 42 cardiac patients, and were revised to make them more parsimonious. The final models were tested with a novel group of 647 CAD patients from Alberta, Canada (327 urban-living, 320 rural-living). The primary analysis was focused on determining the extent to which patients completing the survey fell in the correct behavioral group. Thereafter individual nodes were examined to determine decision-making constructs that were different between urban- and rural-living patients.

Results

When tested, the models had overall accuracy of 93.5% for diet and 97.5% for physical activity. The most salient model nodes that led to differing behavioral outcomes reflected these constructs: perception of control over health; time, effort, or competing priorities; receipt of appropriate information; and appeal of the activity.

Conclusions

This information is potentially useful to assist healthcare providers to: (1) understand patients’ decisions regarding their cardiac risk factor modification behavior, and (2) better direct conversations about risk factor modification and educational activities.     

Identifying and assisting low-literacy patients with medication use: a survey of community pharmacies

BACKGROUND: Nearly one-half of adult Americans have limited functional literacy skills. Low patient literacy is associated with poor medication adherence and health outcomes. However, little is known about how pharmacies address literacy-related needs among patrons. OBJECTIVE: To determine the frequency with which pharmacies identify and provide appropriate assistance to patients with limited literacy skills and provide specific recommendations to help improve pharmacists' recognition of low health literacy, as well as strategies to improve adherence in this population. METHODS: Through a telephone-based survey of Atlanta-area pharmacies, we obtained information on (1) whether the pharmacy attempted to identify patients with limited literacy skills, (2) what measures were taken by the pharmacy to optimize the health care of low-literacy patients, especially with regard to medication adherence, and (3) what services the pharmacy offered to improve adherence in general. RESULTS: The response rate among eligible pharmacies was 96.8% (N = 30). Only 2 (7%) pharmacies reported attempting to identify literacy-related needs among their patrons. One of these facilities provided additional verbal counseling to assist low-literacy patients, and the other pharmacy involved family members, provided verbal counseling, and had patients repeat instructions to confirm comprehension. Most pharmacies reported availability of adherence aids that could help low-literacy patients if such patients were identified and targeted to receive additional assistance. These included verbal and written counseling (offered at 73% of pharmacies), packaging or organizing aids (27%), refill services (17%), and graphic or multimedia aids (13%). CONCLUSIONS: Pharmacies infrequently attempt to identify and assist patients with limited literacy skills.     

Multifactorial approach and adherence to prescribed oral medications in patients with type 2 diabetes

The aims of this study were to assess adherence to oral hypoglycaemic/cardiovascular drugs and determine non-adherence predictors in type 2 diabetes patients. It was designed as a population-based cross-sectional study in which 90 patients from a primary care setting were studied. Pill count and self-report methods were used to measure adherence. Logistic regression analysis was performed to predict factors related to non-adherence. Adequate adherence to all drugs was found in 29 patients (35.4%; 95% confidence interval (CI) 25.0-45.7). Variables associated with non-adherence were HbA1c odds ratio (OR) 2.32 (95% CI: 1.09-4.95), systolic blood pressure OR 1.68 (95% CI: 1.08-2.62), total cholesterol OR 1.34 (95% CI: 1.08-1.66), number of pills OR 1.80 (95% CI: 1.26-2.55) and duration of disease OR 0.44 (CI 95%: 0.24-0.83). In conclusion, one in three patients had adequate adherence. Factors associated with non-adherence were duration of disease, complexity of drug regimen and inadequate control of cardiovascular risk factors.     

Cognitive function and adherence of older adults undergoing hemodialysis.

As the number of older adults undergoing hemodialysis increases, it is important for nurses to consider cognitive impairment as a contributing factor to non-adherence. The purpose of this exploratory study was to identify cognitive markers that nurses can use to alert them to potential problems with adherence among older adults undergoing hemodialysis. Stories of the health challenge of making lifestyle change were analyzed with a linguistic analysis software program. A standardized instrument (3MS) that measures global cognitive function was administered. Determination of adherence level was the last activity of data collection. In this sample (n=63), 39.7% of the participants had evidence of cognitive impairment (3MS score less than 80); 58.2% of the 39.7% had evidence of non-adherence. There was a significant relationship between word use and cognitive function (p < .01). Cognitive impairment is prevalent among older adults undergoing hemodialysis and words might be a proxy for recognizing this.     

Non-adherence to HIV antiretroviral medications: 'The drugs are working and I'm a continuing success story'.

Non-adherence to antiretroviral (ARV) regimens has been associated with HIV drug resistance. Anecdotal evidence in our client group, people living with HIV/AIDS infection in Central Sydney Area Health Service (CSAHS), suggested that non-adherence was an issue. Eighty three participants completed an anonymous questionnaire; with a 98% response rate. The mean age of respondents was 44 years with 68% over age 40 years. 68% of respondents missed doses of ARV, 54% because they forgot. 54% stated they did not report the non-adherence to their doctor. They were more likely to miss the lunch time dosage (n=49, p<0.05). The results demonstrate that non-adherence with medications is a significant issue and further research into strategies for interventions to aid adherence is required.     

The effect of adherence therapy on medication adherence,health beliefs,self-efficacy,and depressive symptoms among patients diagnosed with major depressive disorder

Medication adherence is a crucial health issue in major depressive disorder (MDD) that requires regular monitoring and attention. Hence, there are multiple reasons for medication non-adherence among them. This study aimed to examine the effect of adherence therapy (AT) on medication adherence, health beliefs, self-efficacy, and depressive symptoms among patients diagnosed with MDD. One group pretest-posttest, repeated measures time-series design was conducted. A sample of 32 patients was recruited conveniently; they received eight weekly sessions of AT. A self-reported questionnaire was used to measure variables. The analysis showed that the mean scores of the baseline indicated non-adherence, moderate general benefits beliefs about the medication, high beliefs that medication is harmful, high beliefs that doctors overuse medication, high beliefs about potential adverse effects from medication, low perception of MDD severity, and high threatening perception regarding MDD, a moderate degree of confidence in the ability to taking medications, and patients had moderately severe depressive symptoms (M = 16, 3.2, 3.1, 4.1, 3.8, 50, 3, 16 respectively). Over four measurement points, adherence therapy enhanced positive beliefs towards taking medication and illness, increased medication adherence self-efficacy, improved medication adherence, and decreased depressive symptoms (F = 68.57–379.2, P < 0.001). These improvements were clinically significant in all variables immediately post-AT but declined minimally over time. The study indicated that integrating AT as part of the pre-discharge protocol is one core component to sustaining positive healthcare outcomes. Continuous efforts should be paid in terms of the long-term sustainability of an intervention to enhance adherence and clinical outcomes.