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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (9): 124-129.doi: 10.6040/j.issn.1671-7554.0.2021.0911

• 专家综述 • 上一篇    下一篇

慢性病管理依从问题研究的困境及“破局”思路

王克芳,吴臣   

  1. 山东大学护理与康复学院, 山东 济南 250012
  • 发布日期:2021-10-15
  • 通讯作者: 王克芳. E-mail:wangkf@sdu.edu.cn
  • 基金资助:
    国家重点研发计划(2020YF2008800)

Dilemmas and thoughts on solutions of adherence to chronic disease management

WANG Kefang, WU Chen   

  1. School of Nursing and Rehabilitation, Shandong University, Jinan 250012, Shandong, China
  • Published:2021-10-15

摘要: 慢性病是影响人群健康及国家社会经济发展的重大公共卫生问题,慢性病管理是现阶段许多国家的重要议题,管理方案依从不佳是慢性病管理过程中的“卡脖子”问题。本文描述了慢性病管理过程与管理方案依从的嵌套模型,梳理了当前国内外慢性病管理过程中依从问题的切片式研究态势,并从本体论、认识论和方法论视角提出应对慢性病管理依从不佳问题的新思路,为构建慢性病管理依从促进、维持系统,应对我国慢性病管理的困境助力。

关键词: 慢性病, 疾病管理, 治疗依从性, 研究范式, 过程管理

Abstract: Chronic diseases are a major public concern resulting in substantial social and economic consequences globally. The suboptimal adherence to strategies of chronic disease management is the “bottleneck” issue that should be addressed across countries. This paper describes the nested theoretical model integrating the process of chronic disease management and adherence to management strategies derived from both empirical and theoretical evidence, summarizes the arguments on the “salami slicing” actions adopted by researchers in adherence promotion studies, and proposes our thoughts on solutions of adherence to management strategies via the lens of ontology, epistemology, and methodology. Efforts in this paper may imply future researchers to develop a system to promote and maintain adherence to management strategies among patients with chronic diseases, and facilitate the chronic disease management in China.

Key words: Chronic disease, Disease management, Treatment adherence, Research paradigm, Process management

中图分类号: 

  • R199
[1] World Health Organization. Adherence to long-term therapies: evidence for action [EB/OL].(2003-01)[2021-08-10]. https://www.who.int/chp/knowledge/publications/adherence_full_report.pdf?ua=1.
[2] May CR, Eton DT, Boehmer K, et al. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness [J]. BMC Health Serv Res, 2014, 14: 281. doi:10.1186/1472-6963-14-281.
[3] Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 [J]. Lancet, 2019, 394(10204): 1145-1158.
[4] 中华人民共和国中央人民政府. 国务院办公厅关于印发中国防治慢性病中长期规划(2017—2025年)的通知[EB/OL].(2017-01-21)[2021-07-28]. http://www.gov.cn/zhengce/content/2017-02/14/content_5167886.
[5] 豆丽园, 黄娟, 叶森, 等. 社区老年慢性病共存患者治疗负担现状及影响因素研究[J]. 中国全科医学, 2021, 24(13): 1671-1675. DOU Liyuan, HUANG Juan, YE Sen, et al. Treatment burden and influencing factors of elderly patients with multimorbidity in the community[J]. Chinese General Practice, 2021, 24(13): 1671-1675.
[6] 阮婷婷, 王婷婷, 席荣古丽·哈力力, 等. 慢性病患者治疗负担研究现状[J]. 中国护理管理, 2017, 17(12): 1687-1691. RUAN Tingting, WANG Tingting, XIRONGGULI Halili, et al. The status of research on the treatment burden in patients with chronic diseases [J]. Chinese Nursing Management, 2017, 17(12): 1687-1691.
[7] Sav A, Salehi A, Mair FS, et al. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature [J]. BMC Med Res Methodol, 2017, 17(1): 140.
[8] Okemah J, Peng J, Quiñones M. Addressing clinical inertia in type 2 diabetes mellitus: a review [J]. Adv Ther, 2018, 35(11): 1735-1745.
[9] 黄婉琳, 廖晓琴, 李丽萍, 等. 基于知识图谱的慢性病长期照护研究热点和趋势分析[J]. 中国实用护理杂志, 2017, 33(21): 1674-1680. HUANG Wanlin, LIAO Xiaoqin, LI Liping, et al. Research hotspots and trend in chronic diseases' long-term care based on knowledge map [J]. Chinese Journal of Practical Nursing, 2017, 33(21): 1674-1680.
[10] Reynolds R, Dennis S, Hasan I, et al. A systematic review of chronic disease management interventions in primary care [J]. BMC Fam Pract, 2018, 19(1): 11.
[11] World Health Organization. Innovative care for chronic conditions: building blocks for actions: global report?(No. WHO/MNC/CCH/02.01)[EB/OL].(2002-10-31)[2021-08-10]. https://www.who.int/chp/knowledge/publications/icccglobalreport.pdf?ua=1.
[12] Haverfield MC, Tierney A, Schwartz R, et al. Can patient-provider interpersonal interventions achieve the quadruple aim of healthcare? a systematic review[J]. J Gen Intern Med, 2020, 35(7): 2107-2117.
[13] McQuaid EL, Landier W. Cultural issues in medication adherence: disparities and directions [J]. J Gen Intern Med, 2018, 33(2): 200-206.
[14] Gardner B, Rebar AL. Habit formation and behavior change [EB/OL].(2019-04-26)[2021-06-06]. https://oxfordre.com/psychology/view/10.1093/acrefore/9780190236557.001.0001/acrefore-9780190236557-e-129.
[15] Gardner B. A review and analysis of the use of 'habit' in understanding, predicting and influencing health-related behavior [J]. Health Psychol Rev, 2015, 9(3): 277-295.
[16] Dodd M, Janson S, Facione N, et al. Advancing the science of symptom management [J]. J Adv Nurs, 2001, 33(5): 668-676.
[17] 李春林, 丁韶丽, 丁兴宇. 基于健康生态学模型分析老年高血压患者自我管理现况[J]. 中国老年学杂志, 2017, 37(8): 2040-2042. LI Chunlin, DING Shaoli, DING Xingyu. Analyzing self-management among older adults with hypertension based on the social ecological model [J]. Chinese Journal of Gerontology, 2017, 37(8): 2040-2042.
[18] 华丽, 李新宇, 朱伟萍, 等. 2型糖尿病患者自我管理行为的社会生态模型——结构方程模型的验证[J]. 中国卫生统计, 2014, 31(3): 437-439. HUA Li, LI Xinyu, ZHU Weiping, et al. The self-management behaviors among type 2 diabetic patients under the Social Ecological Model: an analysis with structural equation modeling [J]. Chinese Journal of Health Statistics, 2014, 31(3): 437-439.
[19] 韩丽, 吴臣, 刘欣. 青年糖尿病患者治疗依从性影响因素的质性研究[J]. 齐鲁护理杂志, 2017, 23(21): 39-41. HAN Li, WU Chen, LIU Xin. Factors influencing treatment adherence in young adults with diabetes: a qualitative study [J]. Journal of Qilu Nursing, 2017, 23(21): 39-41.
[20] Marinho FS, Moram CBM, Rodrigues PC, et al. Treatment adherence and its associated factors in patients with type 2 diabetes: results from the Rio de Janeiro type 2 diabetes cohort study [J]. J Diabetes Res, 2018: 8970196. doi:10.1155/2018/8970196.
[21] Huang Z, Tan E, Lum E, et al. A smartphone app to improve medication adherence in patients with type 2 diabetes in Asia: feasibility randomized controlled trial [J]. JMIR Mhealth Uhealth, 2019, 7(9): e14914. doi:10.2196/14914.
[22] Hedegaard U, Kjeldsen LJ, Pottegård A, et al. Improving medication adherence in patients with hypertension: a randomized trial [J]. Am J Med, 2015, 128(12): 1351-1361.
[23] 张春慧, 陈静, 张振香, 等. 家庭跟进式护理对社区老年脑卒中患者康复依从性的影响[J]. 中国老年学杂志, 2013, 33(7): 1636-1637. ZHANG Chunhui, CHEN Jing, ZHANG Zhenxiang, et al. The impact of family follow-up nursing on rehabilitation adherence among community elderly patients with cerebral apoplexy [J]. Chinese Journal of Gerontology, 2013, 33(7): 1636-1637.
[24] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3): 170-205. Chronic Obstructive Pulmonary Disease group under the Respiratory Society of Chinese Medical Association, Chronic Obstructive Pulmonary Disease Committee under the Respiratory Doctors Branch of Chinese Medical Doctor Association. Guidelines for the diagnosis and management of chronic obstructive pulmonary disease(revised version 2021)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2021, 44(3): 170-205.
[25] 国家老年医学中心, 中华医学会老年医学分会, 中国老年保健协会糖尿病专业委员会. 中国老年糖尿病诊疗指南(2021年版)[J]. 中华糖尿病杂志, 2021, 13(1): 14-46. National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well Association. Guideline for the management of diabetes mellitus in the elderly in China(2021 edition)[J]. Chinese Journal of Diabetes Mellitus, 2021, 13(1): 14-46.
[26] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4):315-409. Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition)[J]. Chinese Journal of Diabetes Mellitus, 2021, 13(4): 315-409.
[27] Presley B, Groot W, Pavlova M. Pharmacy-led interventions to improve medication adherence among adults with diabetes: a systematic review and meta-analysis [J]. Res Social Adm Pharm, 2019, 15(9): 1057-1067.
[28] Jia X, Zhou S, Luo D, et al. Effect of pharmacist-led interventions on medication adherence and inhalation technique in adult patients with asthma or COPD: a systematic review and meta-analysis [J]. J Clin Pharm Ther, 2020, 45(5): 904-917.
[29] Reeves L, Robinson K, McClelland T, et al. Pharmacist interventions in the management of blood pressure control and adherence to antihypertensive medications: a systematic review of randomized controlled trials [J]. J Pharm Pract, 2021, 34(3): 480-492.
[30] El Hajj MS, Jaam MJ, Awaisu A. Effect of pharmacist care on medication adherence and cardiovascular outcomes among patients post-acute coronary syndrome: a systematic review [J]. Res Social Adm Pharm, 2018, 14(6): 507-520.
[31] Fuerst JA. The role of reductionism in the development of molecular biology: peripheral or central? [J]. Soc Stud Sci, 1982, 12(2): 241-278.
[32] 李际. 生态学研究中的还原论[D]. 北京: 中国科学院大学, 2012.
[33] Bouton ME. Why behavior change is difficult to sustain [J]. Prev Med, 2014, 68: 29-36. doi:10.1016/j.ypmed.2014.06.010.
[34] Conn VS, Enriquez M, Ruppar TM, et al. Meta-analyses of theory use in medication adherence intervention research [J]. Am J Health Behav, 2016, 40(2): 155-171.
[35] Park YS, Konge L, Artino AR Jr. The positivism paradigm of research [J]. Acad Med, 2020, 95(5): 690-694.
[36] Orsmond GI, Cohn ES. The distinctive features of a feasibility study: objectives and guiding questions [J]. OTJR(Thorofare N J), 2015, 35(3): 169-177.
[37] Steckler A, Linnan L. Process evaluation for public health interventions and research [M]. San Francisco: Jossey-Bass, 2002: 480.
[38] Hernandez JPT. Network diffusion and technology acceptance of a nurse chatbot for chronic disease self-management support: a theoretical perspective [J]. J Med Invest, 2019, 66(12): 24-30.
[39] 何建南. 论恩格斯的辩证综合型科学哲学[J]. 五邑大学学报(社会科学版), 1998(2): 20-25. HE Jiannan. Views on Engels' dialectical and comprehensive philosophy of science [J] Journal of Wuyi University, 1998(2): 20-25.
[40] 张雪. 实用主义范式下的社会科学研究[D]. 太原: 山西大学, 2015.
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