Abstract: Objective　To explore the associated factors for the adherence to prescribed Chinese and Western medications in patients with chronic kidney disease（CKD） by using the Delphi consultation.Methods　In this study carried out between April and September 2017，we recruited 23 experts in the field of Chinese and Western medicine nephrosis，and conducted a three-round Delphi expert consultation for investigating their appraisal of each item in our pre-designed knowledge-belief-behavior based questionnaire.Results　Total 44 items were formed after three-round expert consultation.The knowledge part comprises 18 items（e.g.curative effects，side effects，naming and methods of administration），each of them achieved over 90% recognition rate.Nineteen items（e.g.harmonious interaction，clear mind，and relaxed mood due to medication） constitute the belief part，and 12 out of them（e.g.richer energy，lower likelihood of hospitalization，and relaxed mood after medication） won over 90% recognition rate.The behavior part consists of 7 items（e.g.missing medication，overlooked medication，medication cessation against prescription after symptomatic relief），5 of which（e.g.missing medication，overlooked medication，medication cessation against prescription after symptomatic relief） gained over 90% recognition rate.Conclusion　The factors affecting the compliance of CKD patients include the degree of patients' understanding of daily medication, the understanding of  decocting of Chinese medicine and the acceptance of the taste of traditional Chinese medicine, the self feeling after taking the medicine, the effect and prognosis of the treatment, and the influence of daily life on the medicine.Patient education focusing on significant associated factors for medication adherence to boost positive medication belief and avoid negative medication belief may improve medication adherence in patients with CKD and clinical benefits.

Key words: Nephrosis, Medication adherence, Traditional Chinese medicine, Expert consultation

摘要： 目的　基于专家咨询法探讨慢性肾脏病（CKD）患者中西医服药依从性的影响因素。方法　于2017年4—9月共选取23名中西医肾病领域专家，以知信行理论为基础形成调查问卷，包括知识部分、信念部分和行为部分，进行3轮调查问卷，记录每个条目的专家认可率。结果　经过3轮问卷调查，共形成44个条目。知识部分包括药物治疗作用、药物不良作用、药物名称及用法等18个条目，专家认可率均>90%；信念部分包括服药能让人相处融洽、服药能让人思维清晰、服药能让人更有活力等19个条目，其中服药能让人更有活力、服药能让人减少住院、服药能让人更轻松等12个条目的专家认可率均>90%；行为部分包括忘记服药、不注意服药、症状改善自行停药等7个条目，其中忘记服药、不注意服药、症状改善自行停药等5个条目的专家认可率均>90%。结论 　CKD患者服药依从性影响因素包括患者对日常服用药物了解的程度、对中药煎煮的了解及中药味道的接受程度、服药后自我感觉、治疗效果和预后、日常生活对服药的影响等。针对服药依从性影响因素进行临床宣教，建立正性信念，避免负性信念，可能会有效改善CKD患者服药依从性，提高临床疗效。

关键词: 肾病, 服药依从性, 中医药, 专家咨询