以質性研究探討影響腎臟移植病人服藥順從性的因素

Abstract

隨著醫療的進步，器官移植逐漸成為慢性腎病病人在透析治療以外的選擇之一，術後最重要的移植用藥，則成為能否維持器官存活的重要關鍵。病人的服藥順從性容易受到多面向的影響，不僅只有服藥困難度、藥物副作用等，病人返家後的生活狀態改變、個人動機與理念、社會支持與醫療協助等，皆為干擾服藥順從性的原因之一。本研究透過質性研究方法，以一對一半結構式訪談的方式深入了解病人術後返家後所面臨的情境以及對於服藥的態度與看法，歸納出影響服藥順從性的原因可以有生理因素、心理因素及實際經驗造成的影響因素。病人對於移植後用藥的感受不僅與藥物本身的作用有關，日常生活的影響、心理的壓力以及病人對整體治療的看法，皆可能左右服藥動機。目前以提升知識與識能為主的藥事照顧模式，可能較不足以滿足每位病人返家後實際的需求。移植後的藥事照顧服務應從術前的用藥評估開始進行並延續到術後的長期追蹤，了解病人的需求進行滾動式服藥方式調整，並針對可能是低服藥順從性的高風險族群進行即時的介入，是增進移植術後病人服藥順從性的方法之一。

Renal transplantation has gradually become one of the treatments for patients suffering from end-stage kidney disease. Taking the immunosuppressant as prescribed is the most important thing for those renal transplant recipients to maintain stable graft functioning after surgery. Patients’ medication adherence is affected by multifaceted factors, including pill burden, drug-related problems, lifestyle changes, self-motivation, and social or medical support. This study aimed to understand post-discharge issues and the attitude toward taking medication among by patients who have undergone renal transplantation, by using qualitative semi-structured interviews. The findings showed that the key factors affecting medication adherence can be classified into three categories: physical factors, psychological factors, and life experiences. Patients’ experiences after transplantation were not only related to the drug effect, but also the influence of daily routine, stress, and perceptions of treatment. As a result, the motivation for taking medication was affected. Pharmaceutical services that focus on improving knowledge alone do not meet all the needs of the patients. To improve medication adherence, the pharmaceutical care for post-transplant recipients should start with the pre-transplant evaluation and conclude by the post-operative long-term follow-ups. Monitoring the risk factors of medication adherence and the provision of adequate medical consultation and support is recommended.