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Patient centered care approach to adherence with cardiovascular medications: Self-determination theory integration.

机译：以患者为中心的依从心血管药物的护理方法：自决理论的整合。

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摘要

Problem statement. Behavioral intervention is used to improve adherence with medication in patients with cardiovascular diseases (CVD), but the effect was not sustainable. Patient-centered care (PCC) as a consumer movement has gained acceptance, but it lacks a theoretical framework. Self-determination theory (SDT) may provide an alternative to improve patients' adherence to chronic cardiovascular medication, as well as a theoretical framework for PCC. Both approaches to CVD management have not been evaluated.Methods. The study was a quasi-experimental pretest posttest comparison design with consecutive sampling of a hospitalized cardiac patient population. Sixty patients each for the usual care (UC) group and the PCC group were recruited. The patient sample consisted of 83% Caucasian, 39% female, 93% insured, an average age of 68 years old, 43% had a NYHF classification of three and above, and an average of 9.7 prescriptions at discharge. A medication teaching intervention was supported by an interactive system designed for PCC. The intervention addressed patients' socioeconomic needs, health literacy adequacy, illness level, timing and amount of teaching, and psychological needs for competence, relatedness, and autonomous motivation. Patients were surveyed once before discharged from the hospital and once three months post discharge.Results. The SDT motivation variables (perceived competence, perceived autonomous support and autonomous motivation) were significantly correlated with the adherence index. Stepwise multivariate regression analyses identified autonomous motivation as an independent predictor of adherence index, along with age, insurance coverage, adverse drug reaction, adequate health literacy, illness level and number of prescription doses taken per day. Patients in the PCC group had significantly higher scores on all three SDT motivation variables, adherence index and higher portion of adherence status than patients in the UC group. Sequential logistic regression analyses reported that PCC intervention, perceived competence and autonomous motivation were independent predictors of adherence status, as well as adverse drug reaction, illness level and number of doses taken per day.Conclusion. Self-determination theory helped to explicate patients' adherence behavior. A patient-centered care environment designed with SDT improved patients autonomous motivation, which improved cardiac patients' adherence to CVD medications.
机译：问题陈述。行为干预用于改善心血管疾病（CVD）患者对药物的依从性，但这种效果并不可持续。以消费者为中心的以患者为中心的护理运动（PCC）已获得认可，但缺乏理论框架。自决理论（SDT）可能为改善患者对慢性心血管药物的依从性提供了一种替代方法，也为PCC提供了理论框架。尚未对这两种CVD管理方法进行评估。这项研究是准实验前测试后测试的比较设计，其中对住院的心脏病患者人群进行了连续采样。分别招募了60名常规护理（UC）组和PCC组患者。该患者样本包括83％的白人，39％的女性，93％的参保者，平均年龄68岁，43％的NYHF分级为3以上及平均出院时处方9.7。为PCC设计的交互式系统支持药物教学干预。干预措施解决了患者的社会经济需求，健康素养充足，疾病水平，授课时间和数量以及能力，亲和力和自主动机的心理需求。对患者出院前和出院后三个月进行了一次调查。 SDT动机变量（感知能力，感知自主支持和自主动机）与遵守指数显着相关。逐步多元回归分析确定了自主动机是依从性指数，年龄，保险范围，药物不良反应，足够的健康素养，疾病水平和每天服用处方剂量的独立预测指标。 PCC组的患者在所有三个SDT动机变量，依从性指数和依从性状态的分数上均显着高于UC组。顺序Logistic回归分析报告说，PCC干预，感知能力和自主动机是依从性状态以及药物不良反应，疾病水平和每天服用剂量数量的独立预测因素。自决理论有助于阐明患者的依从行为。以SDT设计的以患者为中心的护理环境改善了患者的自主动力，从而改善了心脏病患者对CVD药物的依从性。

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  • 作者

    Li, David S.;

  • 作者单位

    Old Dominion University.;

  • 授予单位 Old Dominion University.;
  • 学科 Health Sciences Medicine and Surgery.Health Sciences Pharmacy.Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 185 p.
  • 总页数 185
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 古生物学;
  • 关键词

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