影響愛滋感染者服藥遵從行為之因素分析

Analyzing the Factors for the Adherence of Therapy in HIV-infected Patients

愛滋病的治療隨著藥物不斷地改進，而有良好的控制效果，然而，仍然有些感染者不願意遵照醫囑服藥或停止服藥。由於愛滋病是否有效控制與感染者的服藥遵從行為有決定性的關連，所以本研究透過質化研究的方式，從樣本本身的觀點探討並分析影響服藥遵從行為的真正原因，以作為實務工作者之參考。研究主要發現如下：一、在疾病認知方面，受訪者本身對長期不可間斷服藥的看法，是影響服藥遵從行為的關鍵原因。二、在社會支持方面，知道真實病情的家人與親友比較能給予個案適切的援助。三、在醫病關係方面，受訪者對醫病關係的期待是影響服藥遵從行為的最大關鍵所在。四、在處方特質方面，藥物副作用與服藥次數不再是受訪者停藥或不穩定服藥的主要原因，取而代之是病情穩定之復，他們會重新思考未來的生活目標，與是否能達成此目標，作為評估值不值得繼續服藥的依據，進而思考服藥的意義何在。五、在情境因素方面，阻礙服藥的社會情境因素，如：服藥的隱私性問題等，隨著處方特質的改善，不再是影響服藥遵從行為的因素。

Control and therapy of AIDS has improved over the recent years with the development of new antiretroviral drugs. In particular, in 1997, HAART (highly active antiretroviral therapy) was introduced into Taiwan and became available to AIDS patients. But at that time, this cocktail therapy was complicated to prescribe with multiple dosing and had many side effects. These two factors were thought to be the main reasons patients took their medications irregularly. Although problems with medication and side effects have improved in the recent years, some patients are still unwilling to listen to doctors or simply just stop taking medication. Due to the correlation between control of AIDS and adherence to taking medication, this study adopts a qualitative method to conduct interviews on 17 subjects based on factors affecting adherence to taking medication found in foreign literature review. We aimed to find the real reasons for failure to adhere to medication from the point of view of the study subjects. 1. In terms of cognition of disease, after receiving the treatment for a period of time, study subjects felt the disease has been controlled and most of them also felt optimistic toward therapy, but this does not guarantee adherence to taking medication. The key to adherence is the point of view of study subjects on taking long term medication. 2. In terms of social support, sufficient social support helps to improve continual adherence. Whether patients obtain social support or not and the degree of social support, relates to their willingness to reveal the truth about their disease. Families and friends who know the truth can then offer proper help. The main social support which families offer is emotional support, which is what patients requiring long-term medication need. 3. In terms of doctor-patient relationship, doctor's ”affective behavior” and ”active participation model” of doctor-patient interaction helps the patients to better adherence, but the key element is the expectation of the patient concerning the doctor-patient relationship. 4. The drug regimen itself is no longer the main reason for stopping medication or irregular medication. The meaning and value of therapy is re-evaluated by the patients after their disease has stabilized, and is determined by whether treatment enables them to achieve their goals in life. This is the main issue personnel involved in helping AIDS patients should discuss and face with them in the future. 5. With the improvement in drug dosing and regimen, social factors are no longer the major influences on adherence. The major factors causing inadherence is related to changes in routine, such as forgetting to bring medications on a night out. In conclusion, control and therapy of AIDS in the future requires long-term adherence to antiretroviral drugs, which is no longer determined by drug dosing, side effects and social factors; but by the patient’s view on taking long-term medications, the available social and emotional support, doctor-patient relationships and the value of treatment in relation to achieving their goals in life.