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이행증진을 위한 융복합: 신장이식 환자의 면역억제제 투약이행에 대한 주관성

Convergence for adherence: Subjectivity of immunosuppressive medication adherence after kidney transplantation patient

  • 투고 : 2015.03.11
  • 심사 : 2015.06.20
  • 발행 : 2015.06.28

초록

신장이식 후 면역억제제 투약 이행은 신장이식 대상자의 생존율과 삶의 질을 높이는데 필수적인 요소이며, 대상자의 심리사회적 특성이나 치료지침에 대한 태도에 따라 달라질 수 있다. 투약이행 증진을 위해 대상자는 열린 마음으로 필요한 정보를 학습하는 융복합적 태도를 가질 필요가 있다. 신장이식 대상자의 면역억제제 투약 이행에 대한 태도를 알아보기 위해 Q 방법론을 이용하여 면역억제제 투약 이행에 대한 태도 유형과 유형별 특성을 확인하였다. 수집된 자료는 PC QUANL 프로그램에 의한 주인자분석법으로 처리하였다. 신장이식 대상자의 면역억제제 투약이행에 대한 태도는 '긍정적 생활관리형(n=15)', '조마조마한 외모관리형(n=11)', '침울한 망각형(n=7)', '방심하지 않는 가족지지형(n=7)'의 네 가지 유형으로 확인되었다. 신장이식 후 대상자의 면역억제제 투약 이행에 대한 태도의 확인을 통해 반복적이고 개별화된 신장이식 후 면역억제제 투약관리 프로그램의 필요성을 확인할 수 있었다.

After kidney transplantation, immunosuppressive medication is essential to enhance the quality of life and survival of the transplanted patient. To promote the medication adherence, subjects are required to have converged attitude with open mind. Medication adherence will depend on the attitude of the psychosocial characteristics and treatment guidelines. The purpose of this study was to identify the specific types and characteristics of medication adherence in the view of kidney transplanted patients. Q-methodology, a technique for extracting subjective opinions, was used. Forty participants completed the Q-sort activity, rating each statement relative to the others. The collected data were analyzed by QUANL PC program. Four types of medication adherence of kidney transplanted patients were identified: 'positive lifestyle management type', 'vigilant appearance management type', 'somber oblivion type', 'vigilant family support type'. Through the identification of attitudes to medication adherence, repeated and individualized medication adherence program will help to prevent graft rejection.

키워드

참고문헌

  1. Korean Network for Organ Sharing. "Current status of kidney transplantation", Retrieved from http://konos.go.kr (March 12, 2014)
  2. S. H. Oh, E. K. Yoo, "Comparison of quality of life between kidney transplant and Hemodialysis patients". Journal of Korean Academy of Nursing, Vol. 36, No. 7, pp. 1145-1153, 2006. https://doi.org/10.4040/jkan.2006.36.7.1145
  3. M. Chisholm-Burns, C. A. Spivey, "Use of social cognitive theory to guide a medical treatment adherence intervention". International Journal of Interdisciplinary Social Sciences, Vol. 5, pp. 97-109, 2010.
  4. K. Denhaerynck, F. Burkhalter, P. Schafer-Keller, J. Steiger, A. Bock, S. De Geest, "Clinical consequences of non adherence to immunosuppressive medication in kidney transplant patients". Transplantation International, Vol. 22, pp. 441-446, 2009. https://doi.org/10.1111/j.1432-2277.2008.00820.x
  5. M. A. Dew, A. F. DiMartini, A. De Vito Dabbs, et al., "Rates and risk factors for non-adherence to the medical regimen after adult solid organ transplantation". Transplantation, Vol 83, No. 7, pp. 858-873, 2007. https://doi.org/10.1097/01.tp.0000258599.65257.a6
  6. K. Denhaerynck, F. Dobbels, I. Cleemput et al., "Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review". Transplant International, Vol. 18, No. 10, pp. 1121-1133, 2005. https://doi.org/10.1111/j.1432-2277.2005.00176.x
  7. T. E. Nevins, A. J. Matas, "Medication noncompliance: another iceberg's tip". Transplantation, vol. 77, no. 5, pp. 155-171, 2004.
  8. M. S. Kim, M. K. Joo, H. K. Jang, Y. S. Kim, "Establish national databases for the management of organ transplant patients after transplantation". Journal of the Korean Society for Transplantation, Vol. 21, No. 1, pp. 147-160, 2007.
  9. J. L. Lee, H. Park, "A study on self efficacy, coping, and compliance in patients with kidney transplantation". Korean Journal of Adult Nursing, Vol. 27, No. 1, pp. 11-20, 2015. https://doi.org/10.7475/kjan.2015.27.1.11
  10. M. K. Shim, S. Y. Son, "The effects of an individual educational program on self care knowledge and self care behavior in kidney transplantation patients". Journal of East-West Nursing Research, Vol. 18, No. 1, pp. 9-17, 2012.
  11. S. H. Lee, K. H. Kim, H. K. Chung, "A study on the experience of patients with chronic renal failure who have received a kidney transplant". Journal of Fundamentals of Nursing, Vol. 17, No. 9, pp. 79-95, 1999.
  12. M. A. Chisholm, "Identification of dication-adherence barriers and strategies to increase adherence in recipients of renal transplants". Managed Care Interface, Vol. 17, No. 9, pp. 44-48, 2004.
  13. R. L. Kravitz, J. Melnikow, "Engaging patients in medical decision making". British Medical Journal, Vol. 323, pp. 584-585, 2001. https://doi.org/10.1136/bmj.323.7313.584
  14. G. Schmid-Mohler, M. P. Thut, R. P. Wuthrich, K. Denhaerynck, S. De Geest, "Non-adherence to immunosuppressive medication in renal transplant recipients within the scope of the integrative model of behavioral prediction: A cross sectional study". Clinical Transplantation, Vol. 24, No. 2, pp. 213-222, 2010. https://doi.org/10.1111/j.1399-0012.2009.01056.x
  15. E. Sabate, "Adherence to long term therapies. Evidence for Action". Geneva: Switzerland: World Health Organization, 2003.
  16. W. Stephenson, "Q methodology, inter-behavioral psychology, and quantum theory". Psychological Record, Vol. 32, No. 2, pp. 235-248, 1982.
  17. J. E. Lee, J. O. Kim, N. J. Kim, B. H, Kim, "The post traumatic stress disorder based on people's perception type after technological disaster: focused on Sewol ferry disaster". Journal of Korean Society for the Scientific Study of Subjectivity, Vol. 29, No. 2, pp. 5-27, 2014.
  18. B. J. Kim, "Consumer taxonomy using Q methodology". Korea Marketing Review, Vol. 14, No. 4, pp. 53-71, 1999.
  19. M. Tielen, J. van Exel, M. Laging, D. K. Beck, R. Khemai, T. van Gelder, et al., "Attitudes to medication after kidney transplantation and their association with medication adherence and graft survival: A 2-year follow-up study". Journal of Transplantation, Vol. 2014, pp. 1-9, 2014.
  20. H. K. Kim, "Q methodology: philosophy, theories, analysis, and application". Seoul: Communicationbooks, 2008.
  21. S. M. Bartosh, F. C. Ryckman, R. Shaddy, M. G. Michaels, J. L. Platt, S. C. Sweet, "A national conference to determine research priorities in pediatric solid organ transplantation". Pediatric Transplantation, Vol. 12, No. 2, pp. 153-166, 2008. https://doi.org/10.1111/j.1399-3046.2007.00811.x
  22. D. M. Hume, J. P. Merrill, B. F. Miller, G. W. Thorn, "Experiences with renal homotransplantation in the human: report of nine cases". Journal of Clinical Investigation, Vol. 34, No. 2, pp. 327-382, 1955. https://doi.org/10.1172/JCI103085
  23. N. Ichimaru, S. Takahara, "Japan's experience with living- donor kidney transplantation across ABO barrie"r. Nature Clinical Practice Nephrology, Vol. 4, No. 12, pp. 682-692, 2008. https://doi.org/10.1038/ncpneph0967
  24. T. Watanabe, S. Hiraga, "Influence on family psychodynamics on spousal kidney transplantation". Transplantation Proceedings, Vol. 34, No. 4, pp. 1145-1147, 2002. https://doi.org/10.1016/S0041-1345(02)02811-7
  25. K. L. Hardinger, D. L. Bohl, M. A. Schnitzler, M. Lockwood, G. A. Storch, D. C. Brennan, "A randomized, prospective, pharmacoeconomic trial of tacrolimus versus cyclosporine in combination with Thymoglobulin in renal transplant recipients". Transplantation, Vol. 80, No. 1, pp. 41-46, 2005. https://doi.org/10.1097/01.TP.0000162980.68628.5A
  26. K. Denhaerynck, A. Desmyttere, F. Dobbels, P. Moons, et al., "Nonadherence with immunosuppressive drugs: US compared with European kidney transplant recipients". Progress in Transplantation, Vol. 16, pp. 206-214, 2006. https://doi.org/10.7182/prtr.16.3.42x638u8610630k0
  27. M. Chisholm-Burns, B. Pinsky, G. Parker et al., "Factors related to immunosuppressant medication adherence in renal transplant recipients". Clinical Transplantation, Vol. 26, No. 5, pp. 706-713, 2012. https://doi.org/10.1111/j.1399-0012.2011.01589.x
  28. S. De Geest, P. Schafer-Keller, K. Denhaerynck, et al,. "Supporting medication adherence in renal transplantation (SMART): A pilot RCT to improve adherence to immunosuppressive regimens". Clinical Transplantation, Vol. 20, pp. 359-368, 2006. https://doi.org/10.1111/j.1399-0012.2006.00493.x
  29. E. K. Massey, M. Tielen, M. Laging, D. K. Beck, R. Khemai, T. Gelder, W. Weimar, "The role of goal cognitions, illness perceptions and treatment beliefs in self-reported adherence after kidney transplantation: A cohort study". Journal of Psychosomatic Research, Vol. 75, No. 3, pp. 229-234, 2013. https://doi.org/10.1016/j.jpsychores.2013.07.006
  30. J. H. Ahn, N. C. Kim, "A study on t he educational needs of patients with kidney transplants and their family members after discharge from hospital". Journal of Korean Academy of Nursing, Vol. 29, No. 6, pp. 1324-1335, 1999. https://doi.org/10.4040/jkan.1999.29.6.1324