冠狀動脈支架術(shù)后患者治療依從性及干預

Abstract

Coronaryarterystentinghasbecomethestandardofcareforthemanagementofpatientswithcoronaryarterydisease.Treatmentcompliancehasbeenidentifiedasanimportantfactorinthesuccessofcoronarystenting,withnon-complianceincreasingtheriskofadverseclinicaloutcomes.Thispaperaimstoexaminethefactorsthatinfluencecompliancefollowingcoronarystentingandtheinterventionsthatcanbeundertakentoimproveadherencetotherapy.

Introduction

Coronaryarterystentingisaminimallyinvasiveprocedureusedtoopennarrowedorblockedcoronaryarteriestoimprovebloodflowtotheheart.Despitethemanyadvantagesofthisprocedure,non-compliancewithpost-stentingmedicationandlifestylerecommendationshasbeenreportedtobeasignificantproblem.Treatmentnon-compliancemayimpactnegativelyonlong-termclinicaloutcomes.Medicationnon-adherenceiscommonamongstentpatientsandisfrequentlyassociatedwithpoorclinicaloutcomes.Therefore,improvingcomplianceisakeyfactorinimprovingclinicaloutcomesamongpatientswhohavereceivedcoronarystents.

Methods

AsystematicsearchoftheliteraturewasundertakenusingMedline,PubMed,andCochranedatabases.Articleswereincludediftheywereoriginalresearchorreviewarticlesdiscussingtreatmentcomplianceinpatientswhohavereceivedcoronarystents.Articleswereexcludediftheprimaryfocuswasnotontreatmentcomplianceorinterventiontoimprovecompliance.

Results

Themainfactorsthatnegativelyimpactcompliancefollowingcoronarystentingarenumerousandvaried.Theseincludepatient-relatedfactors,medication-relatedfactors,financialfactors,andsocialfactors.Patient-relatedfactorsincludeeducationlevel,literacy,understandingofthemedicationregimenandthediseasecondition,andsupportfromfamilyandhealthcareproviders.Sideeffectsofmedication,regimencomplexity,andcostsoftreatmentaremedication-relatedfactorsthatcanhindertreatmentcompliance.Financialfactors,suchaslackofinsurancecoverage,mayalsonegativelyimpactcompliance.Socialfactors,suchasculturalandreligiousbeliefs,socialsupport,andpatientpreferencefortraditionalmedicine,areadditionalfactorsthatcanaffectcompliancefollowingcoronarystenting.

Therearevariousinterventionsthathavebeenproposedtoimprovecomplianceamongpatientswhohavereceivedcoronarystents.Theseinterventionsincludeeducationandcounseling,remindersystems,simplificationoftreatmentregimens,supportfromhealthcareprofessionals,familyorfriends,andcommunity-basedmultidisciplinarycare.

Educationandcounselingcanassistinimprovingpatientknowledgeofthediseaseconditionandincreaseunderstandingofthenecessarytreatmentregimen.Itisessentialthatthelanguageandterminologyusedintheeducationalmaterialsaresensitivetotheeducationallevelandlinguisticabilitiesoftheindividualpatient.Theprovisionofwrittenmaterialsandinformationprovidedelectronicallyhasbeenshowntobeeffectiveinimprovingtreatmentadherence.

Remindersystemsareusefulforassistingpatientstoremembertheirmedicationschedule.Suchsystemsmayincludepillboxes,electronicreminders,andphonecalls.Theuseofpillboxesandmedicationschedulingapplicationshasbeenshowntobeespeciallyeffectiveinimprovingmedicationcomplianceinpatientswhohavereceivedcoronarystents.

Simplificationoftreatmentregimenscanbeachievedbyreducingthecomplexityofmedicationregimenanddosageschedules.Thesimplificationofmedicationscheduleshasbeenshowntosignificantlyimproveadherenceandreducecomplicationsamongpatientswhohaveundergonecoronarystenting.

Supportfromhealthcareprofessionals,familyandfriends,andcommunity-basedmultidisciplinarycarecanalsoplayimportantrolesinimprovingcompliance.Supportfromhealthcareprofessionalscanbeprovidedbyregularfollow-upappointments,individualcounseling,andpatienteducationprograms.Supportfromfamilyandfriendscanbeprovidedbyencouragingpatienttocomplywiththeirmedicationsandtreatmentregime.Community-basedmultidisciplinarycareincorporatesdiseasemanagementeducation,socialsupport,andoutcome-basedclinicalmanagement.

Conclusion

Treatmentadherenceisanimportantfactorinthesuccessofcoronarystenting.Patient-related,medication-related,financial,andsocialfactorscanimpacttreatmentcomplianceamongpatientswhohavereceivedcoronarystents.Variousinterventionshavebeensuggestedtoimprovecompliance,includingeducationandcounseling,remindersystems,simplificationoftreatmentregimens,