Concerns with medicine and strategic compliance among elderly hypertension patients

• Main Authors: Yu-Lin Huang, 黃昱霖
• Other Authors: Song-Lih Huang
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/34371757725624752854

碩士 === 國立陽明大學 === 公共衛生研究所 === 98 === Objectives Hypertension is one of the leading causes of death. Even though anti-hypertension medicine could control blood pressure well, the overall control rate was frustrating among elderly patients. The objective of this study is to explore elderly patients’ perception of their medication experience, and the effect on medicine taking. Methods With purposive sampling, we invited participants from multi-service centers for the elderly in Taipei City and public health centers in Yunlin and Kaohsiung County to attend focus groups. A total of 75 participants attended the 9 focus groups. Background information was collected by a questionnaire prior to group discussion. Interviews were recorded and transcribed verbatim. Grounded theory analysis technique was used. Results In most patients’ explanatory models, causes of hypertension were considered multiple, which included the nature of blood which could be changed by diet and weather, aging, as well as physical and psychological stress. The onset of hypertension was perceived as episodes, , and the complication most feared was stroke. The treatment considered beneficial included not only medicine, which was thought to enhance blood circulation, but also diet change and exercise. Besides bodily changes, they also thought hypertension was a sign of aging. They needed to face psychological stress of stroke as well as to cope with the sick role associated with aging. For them, medicine was simultaneously a remedy and a toxin, in addition, blood pressure is both a vital sign and an indicator of disease which fluctuates, patients adopt strategies of adjusting dosage according to their perspective of the disease and medicine, trying to strike a balance between the hazards of a stroke on the one hand, and adverse effects on the other, especially nephrotoxicity and drug-induced hypotension. Health professionals and patients are usually interacting within different cultural and social contexts, which may perpetuate the gap between patient and physician with regard to medicine taking. In contrast to the ubiquitous concern that western medicines may damage the kidneys, few patients mentioned the fact that hypertension itself could harm kidneys. Conclusions Although hypertension was a disease without specific symptoms, its’ cureless nature made not only physical but also psychological and life changes in patients’ lives gradually and chronically. Patients needed to adopt a strategy of managing the uncertainties. In addition to the knowledge given by health professionals, patients built the concept of medicine from personal experiences and social networks,; therefore, patients and health professionals were usually within different epistemic contexts. This may help to explain why patients constantly adjust medicines on their own.. Thus, patient education for medicine taking should be based on patient-centered communication, instead of relying solely on one-way health education.