慢性病患藥物治療信守之概念分析

Concept Analysis of Medication Adherence in Patients with Chronic Disease

藥物治療在慢性病的處置占有重要角色，但許多慢性病患因無法信守藥物治療，導致症狀惡化和經常再入院，也因此常被醫護人員歸為不合作的病人。藥物治療信守是個複雜的概念，分析此概念有助於提升以病人為中心的照護。本文旨在進行藥物治療信守之概念分析，採Walker及Avant的分析步驟，分析結果顯示，藥物治療信守的定義性特徵為（1）知曉同意用藥；（2）溝通協商治療方案；及（3）主動持續參與及評價成效。其前因為病人有（1）藥物治療方案；（2）對病人角色之認知與行動能力；及（3）對治療接受準備度。其後果是（1）症狀獲得控制；（2）減少再入院及死亡率；（3）節省醫療成本；（4）提升自尊；及（5）降低憂鬱等。希望藉由此概念分析，提供護理人員對藥物治療信守概念的了解及護理實務應用之參考。

Pharmacotherapy plays an important role in the management of chronic diseases. However, many patients with chronic disease do not adhere to their medication regimen. This results in worsening symptoms and frequent re-hospitalizations. As a result, healthcare providers may view these patients as bad. Medication adherence is a complex concept. Analyzing this concept may assist nurses to improve patient-centered care. This paper uses Walker & Avant's method to conduct a concept analysis of medication adherence. Results show the defining attributes of medication adherence as: (1) knowing and agreeing to the medication; (2) communicating and negotiating the regimen; and (3) active, continuous involvement in and appraisal of the treatment effect. Identified antecedents of medication adherence included the patient having: (1) a prescribed medication regimen; (2) cognitive and action abilities in her/his role as a patient; and (3) level of preparation for medication treatment. Identified consequences of medication adherence include: (1) improving symptom control; (2) decreasing re-hospitalizations and mortality; (3) reducing medical care costs; (4) restoring self-esteem; and (5) diminishing depression. It is hoped that this concept analysis provides a reference for nurses to achieve a better understanding of medication adherence and further improve nursing practice.