進階搜尋


 
系統識別號 U0026-0812200914353737
論文名稱(中文) 多種慢性病老年患者遵從醫囑服藥之障礙
論文名稱(英文) The Barriers to Take Medications as prescribed of Elderly Patients with Multiple Chronic Diseases
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 96
學期 2
出版年 97
研究生(中文) 陳美滿
研究生(英文) Mei-Man Chen
電子信箱 t2693401@mail.ncku.edu.tw
學號 t2693401
學位類別 碩士
語文別 中文
論文頁數 227頁
口試委員 指導教授-陳清惠
口試委員-柯乃熒
召集委員-盧豐華
中文關鍵字 多種慢性疾病  遵從醫囑服藥  障礙  質性多元個案研究法  老年患者 
英文關鍵字 elderly patients  take medication as prescribed  qualitative multi-case study  multiple chronic diseases  barriers 
學科別分類
中文摘要 台灣老人有60%罹患兩種或兩種以上的慢性疾病,慢性病必須仰賴長期服藥來控制,以避免疾病惡化。但過去研究顯示老人未遵從醫囑服藥情形嚴重,不遵從服藥不但影響治療成效,甚至威脅老人的生命。而研究顯示老人對障礙的知覺為影響服藥遵從性最有力的預測因子。由於國內外缺乏罹患多種慢性疾病老年患者遵從服藥之相關研究。因此,本研究旨在瞭解罹患多種慢性病老年患者服藥現況及遵從醫囑服藥之障礙。
本研究採質性研究設計,運用『多元個案研究法』,立意取樣方式中之關鍵性個案取樣,以南部某醫學中心及南部某區域教學醫院門診患者為對象,依據彙整文獻中影響老年患者服藥之因素,自擬半結構式訪談指引,深度訪談十四位罹患兩種以上慢性病且需長期服藥之65歲以上老年患者,並以『理論的命題』為主要分析策略,理論的命題不存在時,將由原始資料中『發展一個描述架構』作為替代選擇。先就單一個案進行初步分析,再進行跨個案比較分析,找出共通原則與導出質性結論。
依資料分析發現多種慢性病老年患者,其就醫歷程與就醫型態複雜,且受多重因素影響,而部分個案有潛在用藥問題或潛在不適當用藥情形。服藥不遵從型態則包含自行調藥、時間或劑量錯誤、停藥、忘記服藥、西藥併用其他療法、與他人分享藥物及使用儲藥等七種。在服藥障礙方面,研究結果延伸了Chen等(2007)發展之『老年慢性病患者長期服藥行為模式』中五大概念之定義與次命題,對西藥的擔心則為新發展之知覺概念。而由於影響多種慢性病老年患者就醫、服藥的因素是多且錯綜複雜,因此,建議以多層面的介入方式與策略,以求徹底改善問題。
英文摘要 There are 60 percent of elderly with two or more chronic diseases. Life long treatment is necessary for these patients to control the progress of diseases. If the elderly failed to take their medications as prescribed, their chronic conditions may be devastating and may lead to hospitalization and even life-threatening. Studies showed that perceived barriers is the most powerful predictor to medication adherence. Less attention has been given to medication adherence among the elderly with multiple chronic diseases. Therefore, the purpose of this study is to examine the barriers of medication adherence behavior among elderly patients with multiple chronic diseases.
Qualitative multi-case study was used. Purposive sampling and in-depth interviews were conducted to collect the data. Fourteen participants over aged 65 with two or more chronic diseases with life long medication treatment were recruited from the OPD in a medical center and a community hospital at southern Taiwan. Based on Chen’s Medication-taking Behavioral Model for Elderly Patients with Chronic Diseases and literature review, semi-structured interview guide was developed. Prior development of theoretical propositions and cross-case-analysis were used for data analysis.
The findings showed that the health-seeking history of participants were complex and influenced by multiple factors. Several participants were under the risk of inappropriate medication regimen. Non-adherence medication taking behaviors included: self-medication, discontinued and misusing medication (timing or dose), combining Western medications with other therapies, sharing medications, and hoarding medications. The barriers of adherence medication taking behavior can be described by five major concepts in Chen’s model except the concept of “worry about taking medication”. The meaning of each concept in original model has been extended under the context of multiple chronic diseases. Due to the complexity of the medication taking behaviors among multiple chronic diseases elderly patients, multi-disciplinary interventions were required to provide a safe and effective medication regimen.
論文目次 中文摘要……………………………………………………………………………………1
英文摘要……………………………………………………………………………………2
致謝…………………………………………………………………………………………4
目錄…………………………………………………………………………………………5
圖表目錄…………………………………………………………………………………..10
附件目錄…………………………………………………………………………………..11
第一章 前言………………………………………………………..……………………..12
第一節 研究背景、動機、重要性……………………………....…………………..…12
第二節 研究目的………………………………………....……………………………..13
第二章 文獻查證………………………………………....………………………………14
第一節 慢性病老年患者服藥行為……………....……………………………………..14
遵從性……………....………………………....………………………............…..……14
服藥遵從…………....………………………....………………………....…..…………15
服藥遵從性之衡量…………....………………………....…………………………......15
慢性病老年患者服藥不遵從的定義與表現…………....……………………………..17
台灣慢性病老年患者常見服藥現象與問題…………....……………………………..17
第二節 老年慢性病患者服藥行為模式…………....………………………............…..18
1. 感受藥效…...…....………………………....………………………....…..………....19
2. 感受醫療伙伴關係…………....…………………………………………….............19
3. 感受醫療現實感…………...……………………....………………………..............19
4. 人際間的影響…….......………………………....………………………..................19
5. 促進因素及阻礙因素…...........………………………....…………………………..19
第三節 影響老年患者遵從醫囑服藥之相關因素與服藥障礙..…..…………………..20
影響老年患者遵從醫囑服藥之相關因素……..………....……………………………20
老年患者遵從醫囑服藥之障礙....……………..………....……………………………22
第四節 質性個案研究法…………....………………………....………………..………23
質性個案研究法………………………………..………....……………………………24
多元個案研究法………………………………..………....……………………………28
第五節 文獻總結…………....………………………....………………………..............31
第三章 研究問題與名詞界定…………....………………………....……………............31
第一節 研究問題…………....………………………....………………………..............31
第二節 名詞界定…………....………………………....………………………..............32
第四章 研究方法…………....………………………....………………………....………33
第一節 研究設計…………....………………………....………………………..............33
第二節 研究對象…………....………………………....………………………..............33
第三節 研究工具…………....………………………....………………………………..34
1. 半結構式的訪談指引....………………………....………………...………………..34
2. 研究者…………....………………………...............………………………..............36
第四節 研究步驟…………....………………………....………………………..............37
1. 接觸參與研究者………....………………………...………………………..............37
2. 前導性研究………....………………………...……………………………..............37
3. 正式訪談與資料收集………………………...……………………………..............38
4. 資料整理………………………...…………………………………………..............38
第五節 研究對象的權益維護…………....………………………....…………………..39
第六節 資料分析…………....………………………....………………………..............40
第七節 研究嚴謹度…………....………………………....……………………………..42
1. 確實性…...…....………………………....………………………....………..............42
2. 可轉移性…...…....………………………....………………………....……………..43
3. 可靠性…...…....………………………....………………………....………………..43
4. 確認性…...…....………………………....………………………....………………..43
5. 三角檢證法…...…....………………………....………………………....…………..44
第五章 研究結果…………………………....………………………....…………………45
第一節 研究參與者特性…………. …………. …………. …………. ………………45
第二節 就醫型態…………. …………. …………. …………. ………………………48
第三節 服藥現況…………. …………. …………. …………. ………………………52
目前用藥與潛在問題…. …………. ………….. …………. ……………………….52
服藥不遵從型態…. …………. ………….. …………. …………………………….56
輔具或輔助方式…. …………. ………….. …………. …………………………….59
第四節 服藥障礙…. …………. ………….. …………. ………………………...........60
1. 感受藥效…. …...…. ………….. …………. …………………………………….66
2. 感受醫療伙伴關係…. …...….. …………. ………………………………...........68
3. 感受醫療現實感…. …...….. …………. ………………………………...............70
4. 人際間的影響…. …...….. …………. ………………………………...................72
5. 對西藥的擔心…. …...….. …………. ………………………………...................73
6. 阻礙因子…. …...…. ………….. …………. …………………………………….74
第六章 討論…. …………. ………….. …………. ………………………………...........82
第一節 就醫型態……. ………….. …………. ……………………………….............82
第二節 服藥現況……. ………….. …………. ……………………………….............85
用藥潛在問題或不適當用藥….. …………. ……………………………………….85
服藥不遵從型態……. ………….. …………. ……………………………………...87
慢性病患者之用藥自我管理/自我調節……. ……………………………………...92
第三節 服藥障礙……. ………….. …………. ……………………………….............93
1. 感受藥效…. …...…. ………….. …………. …………………………….............95
2. 感受醫療伙伴關係…. …...….. …………. …………………………………..….98
3. 感受醫療現實感…. …………………... ……………………………….............100
4. 人際間的影響…. …...….. …………. ……………………………….................101
5. 對西藥的擔心…. …...….. …………. ……………………………….................102
6. 阻礙因子…. …...…. ………….. …………. ……………………………...........104
情境式或動態式的服藥行為模式. …………. ……………………………………114
第七章 結論與建議………....………………………....………………………..............115
第一節 結論………....………………………....………………………......................115
第二節 應用與建議....………………………....………………………......................116
第三節 研究限制…....………………………....………………………......................121
第八章 參考資料…………....………………………....………………………..............122


圖表目錄…………....………………………....………………………....…………………..
表一 遵從性測量方法與缺點…………....………………………....…………………..16
表二 柯氏量表…………....………………………....……………………………....…137
表三 基本資料…………....………………………....………………………............…..47
表四 就醫型態…………....………………………....………………………............…..51
表五 潛在的用藥問題..………....………………………..………………………....…..54
表六 服藥不遵從現況………....………………………....………………………....…..59
表七 服藥障礙跨個案比較分析………………………....…………………............…..62
圖一 慢性病老年患者服藥行為模式…………....………………………....…………..20
圖二 研究步驟…………....………………………....……………………………....…..39


附件目錄…………....………………………....………………………....…………………..
附件一 訪談指引…………....………………………....……………………………....136
附件二 參與研究同意書…………....………………………....………………………141
附件三 訪談程序…………....………………………....……………………………....144
附件四 影響老年患者遵從醫囑服藥之相關因素…………....………………………145
附件五 訪談指引修改……....………………………....………………………............173
附件六 資料分析步驟……....………………………....………………………............177
附件七 就醫型態……....………………………....………………………....................179
附件八 Beers Criteria.………………………....…………………………...................183
附件九 單一個案服藥不遵從型態……………....………………………....................188
附件十 服藥障礙跨個案比較分析……………....………………………....................210
參考文獻 Eisner, E. W., & Peshkin, A. (2006).教育領域的質性研究:持續不斷的爭議(湯梅英譯).台北:文景書局。(原著出版於1990)
Erikson, E. H., Erikson, J. M., & Kivnick, H. Q. (2000).Erikson老年研究報告:人生八大階段(周伶利譯).台北:張老師。(原著出版於1997)
Yin, R. K. (2001).個案研究法(尚榮安譯).台北:弘智文化。(原著出版於1994)
內政部(2005).中華民國九十一年臺閩地區老人狀況調查摘要分析.台北:內政部。
內政部統計處(2006,10月27日).民國94年全民健康保險醫療統計年報.衛生統計資訊網.摘自http://www.doh.gov.tw/statistic/醫療統計年報/94.htm
王乃泓(1999).民眾就醫選擇之研究-分析層級程序法之應用.中華衛誌,18(2),138-151。
王仕圖、吳慧敏(2005).深度訪談與案例演練.於齊力、林本炫編,質性研究方法與資料分析(二版,97-116頁).嘉義:南華大學教社所。
行政院衛生署(2008,6月16日).民國95年衛生統計系列(六)衛生統計動向.衛生統計資訊網.摘自http://www.doh.gov.tw/statistic/data/衛生動向/95/1_95動向壹.doc
行政院衛生署(2008,6月16日).民國95年衛生統計系列(六)衛生統計動向.衛生統計資訊網.摘自http://www.doh.gov.tw/statistic/data/衛生動向/95/5_95動向伍.doc
行政院衛生署家庭計畫研究所(1999).中華民國台灣地區老人狀況調查報告.台北:行政院衛生署。
行政院衛生署國民健康局(2006).民國九十二年台灣地區中老年身心社會狀況長期追蹤(第五次)調查成果報告.台中:衛生署國民健康局。
何蘊芳(2004).老人用藥與藥品交互作用.長期照護雜誌,8(4),391-397。
吳佳蓉、陳清惠、葉忍莉(2002).老年患者服藥行為影響因素的探討.長庚護理,13(2),166-174。
吳祥恩、鄭美玲、盧豐華、張智仁(1995).服藥自我報告:簡易高血壓遵醫囑性方法之評估.中華民國家庭醫學雜誌,5(2),84-91。
李文宏、顏啟華、李孟智(2005).老人周全性評估.基層醫學,20(9),212-218。
李復華(1997).老年人不遵從服用藥物原因之探討.護理雜誌,44(4),69-74。
周銘霆、魏正宗、黃志峰(1995).群醫中心與地區醫院高血壓病患順服性影響因素之比較研究.中華家醫誌,5(1),33-40。
林雨亭(2001).健康的守護神--談家庭醫師的角色功能.全民健康保險,33,29-31。
林佩璇(2000).個案研究及其在教育研究上的應用.於中正大學教育研究所主編,質的研究方法(初版,239-263頁).高雄:麗文文化。
林宮美(1992).求醫行為研究.未發表的碩士論文.台北:國立台灣大學公共衛生研究所。
侯毓昌、黃文鴻(1999).民眾就醫選擇之研究-分析層級程序法之應用.中華衛誌,18(1),34-43。
洪麗珍(2005).老年人的護理評估與計畫.於劉淑娟總校閱,實用老年護理學(151-189頁),台中:華格那。
胡文郁、高紀惠(1992).高血壓患者之知識、健康信念與服藥遵從行為之相關性研究.護理雜誌,39(4),77-89。
胡文郁、曾春典、戴玉慈、余玉眉(1996).高血壓患者服藥遵從行為及相關因素之探討.中華衛誌,15(4),319-332。
胡文郁、戴玉慈、于博芮、余玉眉、曾春典(1999).老年高血壓患者服藥遵從行為及其影響因素之研究.慈濟醫學,11(3),227-235。
胡月娟(1994).慢性病患者所承受的衝擊與因應行為.護理研究,2(2),140-152。
胡幼慧主編(2005).質性研究:理論、方法及本土女性研究實例.台北:巨流。
高淑清(2002).教育研究(二)質性教育研究.於楊國賜主編,新世紀的教育學概論:科技整合導向(初版,517-576頁).台北:學富文化。
張玨、張菊惠、胡幼慧(1997).某醫學中心子宮切除婦女自述醫病溝通探討.中華衛誌,16(1),1-12。
張家銘(2003).老年醫學專科醫師在醫院的角色.台灣老年醫學會大會會刊,第八屆第一次會員大會暨學術研討會,91-92。
張櫻淳(1996).醫院形象定位之研究-以台北市六家醫學中心的家醫科就診民眾為例.未發表的碩士論文.台北:國立台灣大學醫學院公共衛生研究所。
梁煙純(2004).我國多重慢性病患盛行率及醫療利用分析.未發表的碩士論文.台北:國立陽明大學醫務管理所。
畢恆達(1998).社會研究的研究者與倫理.於嚴祥鸞主編,危險與秘密研究倫理(初版,31-91頁).台北:三民。
莊美華、李紀慧、林俊龍(2005).藥師減少可預防性用藥疏失所扮演之角色.慈濟醫學雜誌,17(4S),29-34。
許茜甯、郭虹君、戴慶玲(2002).藥師介入對醫院用藥品質初期分析:某醫學中心「異常處方」執行效益.醫療品質,2(2),15-24。
陳向明(2002a).社會科學質的研究.台北:五南。
陳向明(2002b).教師如何作質的研究.台北:紅葉文化。
陳伯璋(1998).個案研究評析-質的分析.於陳伯璋著,教育研究方法的新取向-質的研究方法(增定二版,121-146頁).台北:南宏。
陳長安(2004).常用藥物治療手冊33期.台北:全國藥品年鑑雜誌社。
陳惠姿(2007).整合性照顧系統.護理雜誌,54(5),5-10。
陳群英、李淑玉(1991).六十五歲以上老人於住院期間和居家服藥行為及其影響因素之探討.衛生行政學刊,12(3),51-58。
陳箐繡(2004).社區本位藝術課程之跨個案比較研究:以三個藝術課程為例.人文藝術學報,3,327-356。
曾淑津(1994).醫療遵從行為.長庚護理,5(2),77-82。
程金瀛、劉淑娟(2004).預防老人用藥錯誤-護理的角色與功能.The Journal of Long-Term Care,8(4),408-414。
黃秀慧、林信男、林慧玲、何蘊芳(2003).藥師參與藥品交互作用偵測之評估.臺灣醫學,7(2),166-173。
黃盈翔、盧豐華(2003).老年患者的用藥問題與原則.台灣醫學雜誌,7(3),385-395。
黃璉華(1996).社區老人用藥教育介入成效之探討.護理研究,4(2),104-114。
黃麗卿、賴和鴻、李龍騰、鍾嫈嫈(1995).社區高血壓病患服藥之遵醫囑性及衛生教育成果-以台北縣平溪鄉、石碇鄉、深坑鄉為例.中華家醫誌,5(3),147-157。
黃洽鑽、劉宏文、黃忠信(1992).高雄醫學院家庭醫學科門診的內容.高雄醫學雜誌,8(2),175-184。
楊文山(1992).台灣地區民眾求醫行為之分析.榮總護理,9(2),121-125。
楊聖信、林君穎、許桂森、張國志(1994).人體藥理學(下冊).台北:藝軒。
楊聖信、林君穎、董桂森、張國志(1993).人體藥理學(上冊).台北:藝軒。
雷若莉(2005).質性研究設計.於李選總校閱,護理研究與應用(二版,197-244頁).台北:華杏。
齊力(2005).質性研究方法概論.於齊力、林本炫編,質性研究方法與資料分析(二版,1-19頁).嘉義:南華大學教社所。
劉玉山、王佳惠、郭乃文(2007).醫院藥師提供用藥指導之態度與行為意向.北市醫學雜誌,4(2),167-181。
劉淑娟(1998).台灣地區老人的健康觀念與健康行為.護理雜誌,45(6),22-28。
劉淑娟(1999).罹患慢性病老人服藥遵從行為及其相關因素之探討.護理研究,7(6),581-593。
劉淑娟(2000).嚴謹度.於陳月枝總校閱,質性護理研究方法(初版,21-57頁).台北:護望。
劉惠瑚(2003).慢性病老人自我照護之生活經驗.未發表的碩士論文.台中:中國醫藥學院護理學研究所。
潘淑滿(2003).質性研究:理論與應用.台北:心理。
蔣欣欣、盧孳豔(1996).健康與疾病的文化觀及現象分析.護理雜誌,43(4),42-48。
鄭怡世(2002).個案研究法之介紹-兼論其在社會工作實務研究中的運用.社區發展季刊,99,415-430。
鄭逸如、吳治勳、黃芸新(2008).慢性病患者之死亡威脅、慢性病威脅與憂鬱:個人建構理論的觀點.中華心理衛生學刊,21(1),51-73。
鄭麗寶(1990).醫療過程中人際互動的社會學分析.未發表碩士論文.台北:國立臺灣大學社會學研究所。
賴世偉(2003).老年人的臨床用藥原則.老年醫學,50,1-6。
賴奕菁(2004).門診老年失眠症患者之安眠藥處方型態及處方問題.未發表的碩士論文.台北:陽明大學衛生福利研究所。
簡志濤(2003).民眾逛醫師行為之初探--以花蓮縣區域醫院門診病患為例.未發表碩士論文.花蓮:慈濟大學醫學研究所。
Arora, N. K., Ayanian, J. Z., & Guadagnoli, E. (2005). Examining the relationship of patients' attitudes and beliefs with their self-reported level of participation in medical decision-making. Medical Care, 43(9), 865-872.
Ascione, F. J. (2005). Medication compliance in the elderly. Generations, 18(2), 28-36.
Balkrishnan, R. (1998). Predictors of medication adherence in the elderly. Clinical Therapeutics, 20(4), 764-771.
Ballentine, N. H. (2008). Polypharmacy in the elderly: Maximizing benefif, minimizing harm. Critical Care Nursing Quarterly, 31(1), 40-45.
Barat, I., Anderson, F., & Damsgaard, E. M. S. (2001). Drug therapy in the elderly: What doctors believe and patients actually do. Journal of Clinical Pharmacology, 51, 615-622.
Bergen, A., & While, A. (2000). A case for case studies: Exploring the use of case study design in community nursing research. Journal of Advanced Nursing, 31(4), 926-934.
Botelho, R. J., & Dudrak, R. (1992). Home assessment of adherence to long-term medication in the elderly. The Journal of Family Practice, 35(1), 61-65.
Braman, A. C., & Gomez, R. G. (2004). Patient personality predicts preference for relationships with doctors. Personality and Individual Differences, 37(4), 815-826.
Chan, TYK. (2006). Prevention of medication error and unintentional drug poisoning in the elderly. Hong Kong Medical Journal, 12(5), 332-333.
Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science & Medicine, 44(5), 681-692.
Charles, C., Gafni, A., & Whelan, T. (1999). Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Social Science & Medicine, 49(5), 651-661.
Chen, C. H., Wu, J. R., Yen, M., & Chen, Z. C. (2007). A Model of Medication Taking Behavior in Elderly Individuals with Chronic Disease. Journal of Cardiovascular Nursing, 22(5), 359-365.
Conrad, P. (1985). The meaning of medications: Another look at compliance. Social Science & Medicine, 20(1), 29-37.
Cramer, J. A. (2004). A systematic review o adherence with medications for Diabetes. Diabetes Care, 27(5), 1218-1224.
Divakaran, V. G., & Murugan, A. T. (2008). Polypharmacy: An undervalued component of complexity in the care of elderly patients. European Journal of Internal Medicine, 19(3), 225-226.
Duhamel, F., Dupuis, F., Reidy, M., & Nadon, N. (2007). A qualitative evaluation of a family nursing intervention. Clinical Nurse Specialist, 21(1), 43-49.
Dunbar-Jacob, J., & Schlenk, E. A. (2001). Patient adherene to treatment regimen. In A. Baum, T. A. Revenson & J. E. Singer (Eds.), Handbook of heaklth psychology (pp. 571-580). Mahwah, NJ: Lawrene Erlbaum.
Dunbar-Jacob, J., Bobachick, P., Mortimer, M. K., Sereika, S. M., & Foley, S. M. (2003). Medication adherence in persons with Cardiovascular Disease. The Journal of Cardiovascular Nursing, 18(3), 209-218.
Elliott, K. S., & Minno, M. D. (2006). Unruly grandmothers, ghosts and ancestors: Chinese elders and the importance of culture in Dementia evaluations. Journal of Cross-Cultural Gerontology, 21(3-4), 157-177.
Elliott, R. A., Ross-Degnan, D., Adams, A. S., Safran, D. G., & Soumerai, S. B. (2007). Strategies for coping in a complex world: Adherence behavior among older adults with chronic illness. In Journal of Internal Medicine. Retrieved April 5, 2007, from http://www.springerlink.com/content/e877330g6wjm5871/
Ennis, K. J., & Reichard, R. A. (1997). Maximizing drug compliance in the elderly. Postgraduate medicine, 102(3), 211-224.
Espino, D. V., Lichtenstein, M. J., Hazuda, H. P., Fabrizio, D., Wood, R. C., Goodwin, J., et al. (1998). Correlates of prescription and over-the-counter medication usage among older Mexican Americans: The Hispanic EPESE study. Journal of American Geriatric Society, 46, 1228-1234.
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Ross Maclean, J., & Beers, M. H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Internal Medicine, 163, 2716-2724.
George, J., & Shalansky, S. J. (2006, June). Predictors of refill non-adherence in patients with heart failure. In British Journal of Clinical Pharmacology. Retrieved November 6, 2006, from http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2125.2006.02800.x
George, J., Munro, K., McCaig, D., & Stewart, D. (2006). Prescription medications: Beliefs, experiences, behavior, and adherence of sheltered housing residents. The Annals of Pharmacotherapy, 40(12), 2123-2129.
George, J., Munro, K., McCaig, D., & Stewart, D. (2006). Risk factors for medication misadventure among residents in sheltered housing complexes. In British Journal of Clinical Pharmacology. Retrieved November 5, 2006, from http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2125.2006.02799.x
Grymonpre, R. E., Didur, C. D., Montgomery, P. R., & Sitar, D. S. (1998). Pill count, self-report, and pharmacy claims data to measure medication adherence in the elderly. The Annals of Pharmacotherapy, 32, 749-754.
Hashimoto, H., & Fukuhara, S. (2004). The influence of locus of control on pteference for information and decision making. Patient Education and Counseling, 22(2004), 236-240.
Hill-Briggs, F. (2003). Problem solving in diabetes self-management: A model of chronic illness self-management behavior. Annals of Behavioral Medicine, 25(3), 182-193.
Hogan, D. B., & Kwan, M. (2006). Patient sheet: Tips for avoiding problems with polypharmacy. Canadian Medical Association Journal, 175(8), 876.
Huang, L.-H. (1996a). Medication-Taking Behavior of the Elderly. Kaohsiung Journal of medical Science, 12, 423-433.
Huang, L.-H. (1996b). Taiwan’s aging population. Will they take their pills? Reflections, 22(4), 16-17.
Jorgensen, T., Johnsson, S., Kennerfalk, A., Wallander, M.-A., & Svardsudd, K. (2001). Prescription drug use, diagnoses, and healthcare utilization among the elderly. The Annals of Pharmacotherapy, 35, 1004-1009.
Kinoshita, H., Kobayashi, Y., & Fukuda, T. (2008). Duplicative medications in patients who visit multiple medical institutions among the insured of a corporate health insurance society in Japan. Health Policy, 85, 114-123.
Konkle-Parker, D. J. (2001). A motivational intervention to improve adherence to treatment of chronic disease. Journal of the American Academy of Nurse Practitioners, 13(2), 61-68.
Kyngas, H., Duffy, M., & Kroll, T. (2000). Conceptual analysis of compliance. Journal of Clinical Nursing, 9(1), 5-12.
Leopold, N. A., Polansky, M., & Hurka, M. R. (2004). Drug adherence in Parkinson's Disease. Movement Disorders, 19(5), 513-517.
Lumme-Sandt, K., Hervonen, A., & Jylha, M. (2000). Interpretative repertoires of medication among the oldest-old. Social Science & Medicine, 50, 1843-1850.
Lundin, D. V. (1978). Medication taking behavior of the elderly: A pilot study. Drug Intelligence and Clinical Pharmacy, 12(78), 518-522.
Lutfey, K. E., & Wishner, W. J. (1999). Beyond "compliance" is "adherence". Diabetes Care, 22(4), 635-639.
Lyder, C. H., Fennie, K., Chen, C., & Fulmer, T. (2000-2001). Appropriate prescribing for elders: Disease management alone is not enough. Medication and Aging, Winter, 55-59.
McCurdy, C., DiCenso, A., Boblins, S., Ludwin, D., Bryant-Lukosius D., & Bosompra, K. (2006). There to here: young adult patients’ perceptions of the process of transition from pediatric to adult transplant care. Prog Transplant, 16(4), 309-316.
McDonnell, A., Lloyd Jones, M., & Read, S. (2000). Practical considerations in case study research: The relationship between methodology and process. Journal of Advanced Nursing, 32(2), 383-390.
McElnay, J. C., Callion, C. R., & Al-Deagi, F. (1997). Self-reported medication non-compliance in the elderly. Europe Journal of Clinical Pharmacology, 53, 171-178.
Merriam, S. B. (1988). Case study in education: A qualitative approach. San Francisco, CA: Jossey-Bass.
Miles, M. B. & Huberman, A. M. (1984). Qualitative data analysis: A sourcebook of new methods. Newbury Park, CA: Sage.
Miller, C. A. (2003). Safe medication practices: Nursing assessment of medications in older adults. Geriatric Nursing, 24(5), 314-315.
Miller, N. H. (1997). Compliance with treatment regimens in chronic asymptomatic diseases. The American Journal of Medicine, 102(2A), 43-49.
Mutchler, J. E., Bacigalupe, G., Coppin, A., & Gottlieb, A. (2006). Language barriers surrounding medication use among older Latinos. In Journal of Cross Cultural Gerontology. Retrieved January 16, 2007, from http://www.faculty.umb.edu/gonzalo_bacigalupe/Language%20Barriers%20Surrounding%20Medication%20Use%20Among%20Older%20Latinos.pdf
Nagelkerk, J., Reick, K., & Meengs, L. (2006). Perceived barriers and effective strategies to diabetes self-management. Journal of Advanced Nursing, 54(2), 151-158.
Neuberger, G. & Woods, C. T. (1995). Alternative modalities. In I. M. Lubkin(Ed.) Chronic illness: Impact and Interventions(3rd ed., pp.396-415). Boston: Jones and Bartlett.
O’Mahony, D. & Gallagher, P. F. (2008). Inappropriate prescribing in the older population: Need for new criteria. Age and Aging, 37(2), 138-141.
Patton, M. Q. (1990). Qualitative evaluation and research methods. California: Sage Publications.
Poppa, A., Davidson, O., Deutsch, J., Godfrey, D., Fisher, M., Head, S., et al. (2004). British HIV association (BHIVA)/British association for sexual health and HIV (BASHH) guidelines on provision of adherence support to individuals receiving antiretroviral therapy (2003). British HIV Association HIV Medicine, 5(suppl. 2), 46-60.
Pound, P., Britten, N., Morgan, M., Yardley, L., Pope, C., & Daker-White, G. et al. (2005). Resisting medicines: A synthesis of qualitative studies of medication taking. Social Science & Medicine, 61, 133-155.
Ryan, A. A. (1999). Medication compliance and older people: A review of the literature. International Journal of Nursing Studies, 36, 153-162.
Salzman, C. (1995). Medication compliance in the elderly. Journal of Clinical Psychiatry, 56(Supp1), 18-22.
Sandelowski, M. (1986). The problem of rigor in qualitative research. Advanced in Nursing Science, 8(3), 27-37.
Schlenk, E. A., Dunbar-Jacob, J., & Engberg, S. (2004). Medication non-adherence among older adults. Journal of Gerontological Nursing, 30(7), 33-43.
Sherbourne, C. D., Hays, R. D., Ordway, L., DiMatteo, M. R., & Kravitz, R. L. (1992). Antecedents of adherence to medical recommendations: Results from the medical outcomes study. Journal of Behavioral Medicine, 15(5), 447-468.
Simpson, R. J. (2006). Challenges for improving medication adherence. Journal of American Medical Association, 296(21), E1-E3.
Simpson, S. H., Farris, K. B., Johnson, J. A., & Tsuyuki, R. T. (2000). Using focus groups to identify barriers to drug use in patients with congestive heart failure. Pharmacotherapy, 20(7), 823-829.
Simpson, S. H., Johnson, J. A., Farris, K. B., & Tsuyuki, R. T. (2002). Development and validation of a survey to assess barriers to drug use in patients with chronic heart failure. Pharmacotherapy, 22(9), 1163-1172.
Stake, R. E. (2000). Case studies. In N. K. Denzin & Y. S. Lincoln (Eds.). Handbook of qualitative research (2nd ed., pp.435-454). Thousand Oaks: Sage publications.
Steinman, M. A., Landefeld, C. S., Rosenthal, G. E., Berthenthal, D., Sen, S., & Kaboli, P. J. (2006). Polypharmacy and prescribing quality in older people. The American Geriatrics Society, 54, 1516-1523.
van Vliet, M. J., Schuurmans, M. J., Grypdonck, M. H. F., & Duijnstee, M. S. H. (2006). Improper intake of medication by elders-Insights on contributing factors: A review of the literature. Research and Theory for Nursing Practice: An Intervention Journal, 20(1), 79-93.
Wahl, C., Gregoire, J. P., Teo, K., Beaulieu, M., Labelle, S., Leduc, B., Cochrane, B., Lapointe, L., & Montague, T. (2004). Concordance, compliance and adherence in health care: Closing gaps and improving outcomes. Research and Theory for Nursing Practice: An Intervention Journal, 20(1), 79-93.
Watt, S. (2000). Clinical decision-making in the context of chronic illness. Health Expectations, 3, 6-16.
Wong, S. YS., Mercer, S. W., Woo, J., & Leung, J. (2008). The influence of multi-morbidity and self-reported socio-economic standing on the prevalence of depression in an elderly Hong Kong population. In Public Health. Retrieved June 4, 2008, from http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2335096&blobtype=pdf
Woo, J., Ho, S. C., Yuen, Y. K., & Lau, J. (1995). Drug use in an elderly Chinese population: Prevalence and associated factors. Gerontology, 41, 98-108.
Wu, J. R., Moser, D. K., Lennie, T. A., Peden, A. R., Chen, Y. C., &Heo, S. (2008). Factors influencing medication adherence in patients with heart failkure. Heart & Lung, 37(1), 8-16.
Wu, J. Y. F., Leung, W. Y. S., Chang, S., Lee, B., Zee, B., Tong, P. C., & Chan, J. C. N. (2006). Effectiveness of telephone counseling by a pharmacist in reducing mortality in patients receiving polypharmacy: Randomised controlled trial. British Medical Journal, 333, 522-527.
Wutoh, A. K., Elekwachi, O., Clarke-Tasker, V., Daftary, M., Powell, N. J., & Campusano, G. (2003). Assessment and predictors of antiretroviral adherence in older HIV-Infected patients. Journal of Acquired Immune Deficiency Syndromes, 33, S106-S114.
Yin, R. K. (1994). Case study research: Design and method (2nd Ed). Newbury Park, CA: Sage.
Zarowitz, B. J. (2006). Medication overuse and misuse. Geriatric Nursing, 27(4), 204-206.
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2010-08-28起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2010-08-28起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw