老年多病共存患者药物自我管理体验的Meta整合

doi:10.3761/j.issn.0254-1769.2024.12.015

摘要/Abstract

摘要：

目的系统评价老年多病共存患者药物自我管理体验，为制订个性化药物自我管理干预方案提供参考。方法系统检索PubMed、Cochrane Library、Embase、CINAHL、Web of Science、Scopus、中国知网、万方数据库、维普数据库、中国生物医学文献数据库中关于老年多病共存患者药物自我管理体验的质性研究，检索时限为建库至2023年11月。按照澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准进行文献质量评价，采用汇集性Meta整合法进行结果整合。结果共纳入9篇研究，提炼出33个研究结果，综合出4个整合结果，12个类别，整合结果包括药物自我管理的客观困境与挑战、药物素养水平较低、愿意进行积极行为尝试、需要多方协助。结论老年多病共存患者药物自我管理的客观困境、较低的药物素养水平会严重影响其健康结局，医护人员应关注患者在药物自我管理过程中的不同体验，识别患者需求，制订针对性的干预支持策略，改善老年多病共存患者的药物自我管理水平。

关键词: 老年人, 多病共存, 药物, 自我管理, Meta整合, 循证护理学

Abstract:

Objective To systematically evaluate the experiences of drug self-management in elderly patients with multiple chronic illnesses，so as to provide references for the development of personalized drug self-management intervention programs. Methods Qualitative research on drug self-management experiences of elderly patients with multiple chronic diseases was retrieved from PubMed，Cochrane Library，Embase，CINAHL，Web of Science，Scopus，CNKI，Wanfang，VIP and SinoMed. The retrieval time limit is from the establishment of the databases to November 2023. The qualitative research quality evaluation criteria of the Joanna Briggs Institute Evidence-based Health Care Center in Australia was used to evaluate quality of studies. The results were integrated by meta-integration method. Results A total of 9 studies were included，and 33 research results were extracted，and 4 integrated results and 12 categories were synthesized. The integration results included the objective dilemmas and challenges of drug self-management，the low level of drug literacy，willingness to engage in positive behavior attempts，need of multi-party assistance. Conclusion The objective dilemmas of drug self-management and low level of drug literacy in elderly patients with multimorbidity will seriously affect their health outcomes. Medical staffs should pay attention to the different experiences of patients in the process of drug self-management，identify the needs of patients，formulate targeted intervention support strategies，and improve the level of drug self-management in elderly patients.

Key words: Aged, Multimorbidity, Medicine, Self-Management, Meta-Synthesis, Evidence-Based Nursing

王春蕾, 韩姗姗, 张文忠, 徐真真, 李静, 赵凤仪, 孙庆祥, 季红. 老年多病共存患者药物自我管理体验的Meta整合[J]. 中华护理杂志, 2024, 59(12): 1505-1511.

WANG Chunlei, HAN Shanshan, ZHANG Wenzhong, XU Zhenzhen, LI Jing, ZHAO Fengyi, SUN Qingxiang, JI Hong. Experiences of drug self-management in elderly patients with multimorbidities：a qualitative Meta-synthesis[J]. Chinese Journal of Nursing, 2024, 59(12): 1505-1511.

图/表 4

图1 PubMed检索策略

Figure 1 Retrieval strategies of PubMed

图2 文献筛选流程

Figure 2 Literature screening process

表1 纳入文献的基本特征（n=9）

Table 1 The basic characteristics of the included literature（n=9）

表2 纳入文献的方法学质量评价结果（n=9）

Table 2 Methodological quality evaluation of included literature（n=9）

参考文献 26

[1]	孙柳, 王莹, 梁嘉贵, 等. 老年人应对慢性病共病体验的Meta整合[J]. 中华护理杂志, 2022, 57(6):748-755. DOI URL
	Sun L, Wang Y, Liang JG, et al. Experience of the elderly coping with multiple chronic conditions:a qualitative meta-synthesis[J]. Chin J Nurs, 2022, 57(6):748-755.
[2]	Zhou X, Zhang D. Multimorbidity in the elderly:a systematic bibliometric analysis of research output[J]. Int J Environ Res Public Health, 2021, 19(1):353.
[3]	Yang C, Lee DTF, Wang XH, et al. Effects of a nurse-led me-dication self-management intervention on medication adherence and health outcomes in older people with multimorbidity:a randomised controlled trial[J]. Int J Nurs Stud, 2022, 134:104314.
[4]	Yang C, Zhu S, Lee DTF, et al. Interventions for improving me-dication adherence in community-dwelling older people with multimorbidity:a systematic review and meta-analysis[J]. Int J Nurs Stud, 2022, 126:104154.
[5]	牛雨昕, 郭永攀, 张春慧, 等. 慢性病共病患者用药体验的Meta整合[J]. 中华护理杂志, 2023, 58(22):2777-2784. DOI URL
	Niu YX, Guo YP, Zhang CH, et al. Medication experiences of patients with chronic multimorbidities:a qualitative Meta-synthesis[J]. Chin J Nurs, 2023, 58(22):2777-2784.
[6]	Dovjak P. Polypharmacy in elderly people[J]. Wien Med Wochenschr, 2022, 172(5/6):109-113.
[7]	Hochberger JM, Lingham B. Utilizing peplau’s interpersonal approach to facilitate medication self-management for psychia-tric patients[J]. Arch Psychiatr Nurs, 2017, 31(1):122-124.
[8]	Institute JB. JBI critical appraisal checklist for qualitative re-search[EB/OL].(2016-08-03)[2023-11-02]. http://joanna briggs.org/assets/docs/critical-appraisal-tools.html.
[9]	Elliott RA, Ross-Degnan D, Adams AS, et al. Strategies for coping in a complex world:adherence behavior among older adults with chronic illness[J]. J Gen Intern Med, 2007, 22(6):805-810. DOI PMID
[10]	Summer Meranius M, Engstrom G. Experience of self-mana-gement of medications among older people with multimor-bidity[J]. J Clin Nurs, 2015, 24(19/20):2757-2764.
[11]	Vandermause R, Neumiller JJ, Gates BJ, et al. Preserving self:medication-taking practices and preferences of older adults with multiple chronic medical conditions[J]. J Nurs Scholarsh, 2016, 48(6):533-542.
[12]	Roux P, Verloo H, Santiago-Delefosse M, et al. The spatial di-mensions of medication management by home-dwelling older adults after hospital discharge[J]. Health Place, 2019, 60:102230.
[13]	王永利, 栾文艳, 郭亚雯, 等. 居家老年多病共存患者多重用药体验的质性研究[J]. 中国全科医学, 2020, 23(17):2197-2202. DOI
	Wang YL, Luan WY, Guo YW, et al. Multiple medication experience of elderly patients with multimobidity at home:a qualitative study[J]. Chin Gen Pract, 2020, 23(17):2197-2202.
[14]	Bieri M, del Río Carral M, Santiago-Delefosse M, et al. Beliefs about polypharmacy among home-dwelling older adults living with multiple chronic conditions,informal caregivers and heal-thcare professionals:a qualitative study[J]. Healthcare, 2021, 9(9):1204.
[15]	Foley L, Hynes L, Murphy AW, et al. ‘Just keep taking them,keep hoping they’ll work’:a qualitative study of adhering to medications for multimorbidity[J]. Br J Health Psychol, 2022, 27(3):691-715.
[16]	Carli Lorenzini G, Bell A, Olsson A. ‘You need to be healthy to be sick’:exploring older people’s experiences with medica-tion packaging at home[J]. Age Ageing, 2022, 51(3):afac050.
[17]	郭姣姣, 刘方, 张春慧, 等. 老年慢性病共病患者参与药物管理体验的现象学研究[J]. 军事护理, 2023, 40(3):19-22.
	Guo JJ, Liu F, Zhang CH, et al. Experiences of participation in medication management among elderly patients with multiple chronic conditions:a phenomenological study[J]. Mil Nurs, 2023, 40(3):19-22.
[18]	Bailey SC, Opsasnick LA, Curtis LM, et al. Longitudinal inves-tigation of older adults’ ability to self-manage complex drug regimens[J]. J Am Geriatr Soc, 2020, 68(3):569-575.
[19]	Foley L, Larkin J, Lombard-Vance R, et al. Prevalence and predictors of medication non-adherence among people living with multimorbidity:a systematic review and meta-analysis[J]. BMJ Open, 2021, 11(9):e044987.
[20]	Crowley EK, Sallevelt BTGM, Huibers CJA, et al. Intervention protocol:optimising therapy to prevent avoidable hospital admission in the multi-morbid elderly(OPERAM):a struc-tured medication review with support of a computerised decision support system[J]. BMC Health Serv Res, 2020, 20(1):220. DOI PMID
[21]	Endestad T, Wortinger LA, Madsen S, et al. Package design affects accuracy recognition for medications[J]. Hum Factors, 2016, 58(8):1206-1216. PMID
[22]	Pons EDS, Moraes CG, Falavigna M, et al. Users’ preferences and perceptions of the comprehensibility and readability of medication labels[J]. PLoS One, 2019, 14(2):e0212173.
[23]	赖粼, 丁四清, 钟竹青, 等. 冠心病患者药物素养的研究进展[J]. 中华护理杂志, 2020, 55(8):1276-1280. DOI URL
	Lai L, Ding SQ, Zhong ZQ, et al. Research progress of medication literacy in patients with coronary heart disease[J]. Chin J Nurs, 2020, 55(8):1276-1280.
[24]	朱佳雪, 刘朝芹, 韩芳芳, 等. 知信行健康教育模式对老年高血压患者服药依从性的影响[J]. 老年医学研究, 2021, 2(3):23-26.
	Zhu JX, Liu CQ, Han FF, et al. Effect of knowledge attitude and practice education model on medication compliance of elderly patients with hypertension[J]. Geriatr Res, 2021, 2(3):23-26.
[25]	Qvarfordt M, Throfast V, Petersson G, et al. Web-based educa-tion of the elderly improves drug utilization literacy:a randomized controlled trial[J]. Health Informatics J, 2021, 27(1):1460458220977585.
[26]	Ahmad A, Chiu V, Arain MA. Users’ perceptions of an in-home electronic medication dispensing system:a qualitative study[J]. Med Devices, 2020, 13:31-39.