痛風病患服藥經驗之探討

Exploring the Experiences of Medication Taking for Patients with Gout

黃雅婷(Ya-Ting Huang) ； 林夷真(Yi-Chen Lin)

《源遠護理》 9卷4期 (2015/12) Pp. 45-55

https://doi.org/10.6530/YYN/2015.1.05

摘要

背景：痛風發作頻繁之病人應長期規則服用降尿酸藥物來控制尿酸濃度，這不僅可以降低痛風的復發率，也減少痛風的相關合併症。然而，根據研究發現痛風病患服用降尿酸藥之遵從性並不高。目的：探討痛風病患服用降尿酸藥物之服藥經驗。方法：採質性研究法，以台中某區域教學醫院採立意取樣收案，透過非結構式深入訪談九位服用降尿酸藥物之病患，並進行資料分析。結果：研究結果歸納出病患服用降尿酸藥物的經驗由五個主題及二十個次主題所構成，分別為一、痛不欲生之回首：疼痛的煎熬、活動的受限、工作的停擺、復發的苦惱；二、痛徹心扉之隱情：執著主觀想法、疏忽按時服藥、取捨藥物種類、擔心藥物副作用、排斥長期服藥、誤信民俗療法；三、痛不堪言之苦衷：醫藥資訊的不足、經濟方面的負擔、醫療處置的缺失、就醫治療的羈絆；四、痛滌前非之決心：疼痛症狀的改善、身體心像的復原、正常工作的回歸；五、痛定思痛之改變：專業醫療的認同、醫療政策的便利、成功典範的學習。結論／實務應用：痛風是一種慢性病，建議長期規則服用降尿酸藥物來控制尿酸濃度，而停藥亦是造成復發的原因。本研究可提供臨床醫護人員未來在改善痛風病患服藥意願的方向，進而提供病患完整且連續之醫護照護。

關鍵字

痛風 ； 服藥 ； 質性 ； 經驗

並列摘要

Background: Patients with frequent gout attack should take medications regularly to control the uric acid level in the blood, prevent gout attacks and reduce related complications. However, research shows that patients’ medication compliance is low. Purpose: To explore patients’ experience and issues related to taking anti-hyperurice medication. Method: This is a qualitative research. Participants were recruited from hospitalized patients in a regional teaching hospital in Taichung, Taiwan, and were selected by purposive sampling. Data was collected from 9 subjects using an in-depth unstructured interview to understand their experiences with taking anti-hyperurice medications. Results: Five major themes and 20 sub-themes were developed: (1) a unbearably melancholic memory: painful suffering, limited activities, tasks suspension, suffering from disease recurrence; (2) miserably hidden secrets: subjective insistence, ignoring taking medicine regularly, choosing favorite medication, worrying about side effects, reluctant to take long-term medications, misbelief in traditional folk remedy; (3) an anguished concern: lack of medical information, an economic burden, mistakes in medical intervention, the restraints in seeking medical intervention; (4) an invincible determination: relieving pain, recovery of self-image, returning to job duty; (5) a successful transformation: acknowledge professional medical orders, benefit from social medical policies, learning from successful role models. Conclusion: Gout is a chronic disease and regular, constant taking of anti-hyperurice medications to control the level of uric acid is important. Self-discontinuation of medication is the main cause for gout relapse. The results of this research provide a guide for medical practitioner to improve patient teaching and medication compliance.

並列關鍵字

gout ； medication taking ； qualitative ； experiences

參考文獻

Harrold, L. R., Mazor, K. M., Velten, S., Ockene, I. S., & Yood, R. A. (2010). Patients and providers view gout differently: A qualitative study. Chronic Illness, 6(4), 263-271. doi:10.1177/1742395310378761.

林佩靜（2011）．尿酸與第二型糖尿病腎病變相關性探討（未發表的碩士論文）．中山醫學大學生化暨生物科技研究所，台中市。〔Lin, P. C. (2011). The Relationship between Uric Acid and Type II Diabetic Nephropathy (Unpublished master's dissertation). Chung Shan Medical University, Taichung, Taiwan.〕

胡曉雲、蔡文正、龔佩珍（2005）．肺結核病患未完成治療原因探討．臺灣公共衛生雜誌，24（4），348-359。〔Hu, H. Y., Tsai, W. C., & Kung, P. T. (2005). Factor Determining the Failed Treatment for Tuberculosis Patients. Tai- wan Journal Public Health, 24(4), 348-359.

莊佩芬（2008）．Allopurinol以及 Benzbromarone在不同腎功能高尿酸血症患者其臨床上劑量和治療效果之評估（未出版碩士論文）．高雄醫學大學。〔Zhuang, P. F. (2008). Allopurinol and Benzbromarone in different renal function in patients with hyperuricemia on clinical assessment and treatment (Unpublished master’s dissertation). Kaohsiung Medical University, Taiwan.〕

陳俊宏、潘文涵（2008）．高尿酸血症與痛風關節炎及心血管疾病死亡關係之前瞻性風險研究（未發表的博士論文）．國立台灣大學流行病學研究所，臺北市。〔Chen, J. H., & Pan, W. H. (2008). A Prospective Study of Hyperuricemia on Gouty Arthritis and Mortality of Cardiovascular Disease (Unpublished master’s dissertation). National Taiwan University, Taipei, Taiwan.〕