慢性病患者用药偏差的概念分析

Concept Analysis of Medication Deviation in Patients with Chronic Diseases

摘要: 目的：运用Rodgers演化概念分析法，深入剖析慢性病患者用药偏差的概念内涵，以期为护理评估、干预策略研究及临床实践提供清晰的概念框架。方法：系统检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Web of Science、Cochrane Library等数据库进行文献筛选，分析概念演化、替代词和相关术语、前因变量、属性特征、后果以及典型案例。检索时间为建库至2025年11月。结果：共纳入文献49篇，英文文献37篇，中文文献12篇。慢性病患者用药偏差的概念属性包括用药行为与治疗方案的执行性偏离，全环节普遍性与过渡期高发性，内在的临床风险属性，可被识别、评估与干预的动态过程四个方面；前因包括个人因素、疾病因素、家庭经济因素；后果涵盖生理功能领域、临床结局领域、资源利用领域、其他领域。结论：通过概念分析明确了慢性病患者用药偏差的概念属性，为临床评估、干预工具开发及护理实践奠定了科学依据。

Abstract: Objective: To conduct an in-depth analysis of the concept of medication deviation in patients with chronic diseases using Rodgers’ evolutionary concept analysis method, with the aim of providing a clear conceptual framework for nursing assessment, intervention strategy research, and clinical practice. Methods: A systematic literature search was performed in databases including CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Web of Science, and Cochrane Library. Literature screening was conducted to analyze the concept’s evolution, surrogate terms and related concepts, antecedents, attributes, consequences, and typical cases. The search period covered from the inception of each database to November 2025. Results: A total of 49 articles were included, comprising 37 in English and 12 in Chinese. The conceptual attributes of medication deviations in chronic disease patients encompass four aspects: deviations in medication behavior and treatment regimen adherence, universality across all care stages with high incidence during transitional periods, inherent clinical risk characteristics, and a dynamic process that is identifiable, assessable, and intervenable. The contributing factors include individual factors, disease-related factors, and family economic factors; the consequences span the domains of physiological function, clinical outcomes, resource utilization, and other relevant areas. Conclusion: This concept analysis clarifies the attributes of medication deviation in patients with chronic diseases, providing a scientific basis for clinical assessment, the development of intervention tools, and nursing practice.