老年慢性病患者用药体验对用药依从性的影响分析
Influencing Factors for Medication Experience and Medication Adherence in Elderly Patients with Chronic Diseases
背景 随着老龄化程度的加剧，老年慢性病患者的规模不断扩大，用药依从性对慢病患者的健康结局至关重要。现有研究大多分析了用药依从性的影响因素和干预措施对提升用药依从性的效果，但从用药体验角度分析对用药依从性的影响的研究还不够全面。目的 了解老年慢性病患者用药体验和用药依从性现状，探讨用药体验多个维度对用药依从性产生的影响作用，就提升老年慢性病患者用药依从性提出对策。方法 2023 年 9—12 月，采用分层随机抽样在山东省内按照经济社会发展水平抽取 3 个地级市共 2 432 位居民，再依据纳入标准筛选出 60 岁以上且长期服药的老年慢性病患者进行调查研究。使用课题组研制的慢病患者用药体验量表调查患者用药体验状况，量表包含 7个维度 28 个条目，采用中文版四条目服药依从性问卷调查患者用药依从性状况。描述患者的用药体验与用药依从性现状，采用多元线性回归分析对患者用药依从性产生重要影响的用药体验维度。结果 本次调查共发放问卷 2 432 份，回收有效问卷 2 415 份，有效回收率为 99.3%；剔除问卷主要变量数据缺失的样本后，共有 1 544 例样本纳入本研究。老年慢性病患者用药体验均分为（4.31±0.39）分，药物的生活影响维度均分最高，为（4.72±0.58）分；方便性维度均分最低，为（3.86±0.49）分。老年慢病患者用药依从性均分为（3.48±0.619）分，筛查出依从性差的患者 698例（45.2%），其服药不依从最主要的表现是“忘记服药”，占比 77.1%（538/698）。女性、患慢性病数量 2 种及以上的老年慢性病患者用药依从性得分与男性、患 1 种慢性病患者相比较低（P<0.05）。多元线性回归结果显示，女性（β=-0.056）、患慢性病数量 2 种及以上（β=-0.053）的老年慢性病患者的服药依从性较差（P<0.05），在用药体验量表的各维度中，有效性维度（β=0.083）、可负担性（β=0.135）两个维度对患者用药依从性具有正向预测作用（P<0.05）。结论 山东省老年慢性病患者用药依从性差的比例为 45.2%，其中女性、患慢性病数量 2 种及以上的老年慢性病患者的服药依从性较差，有效性维度、可负担性两个维度对患者用药依从性具有正向预测作用。相关部门应注意持续降低慢病药物价格，医生应当加强对女性、共病的老年慢性病患者的药事指导服务。
Background With the accelerated population agingthe number of elderly patients with chronic diseases is growingly elevated. Adherence to medication regimens is pivotal for the health outcomes of chronic diseases. Existing research mainly analyzed influencing factors for medication adherence and the outcome of medication adherence by interventions. A single analysis of medication adherence from the aspect of medication experience is one-sided. Objective To understand the current situations of medication experience and medication adherence in elderly patients with chronic diseasesand to explore the influence of medication experience at multiple dimensions on medication adherencethus proposing countermeasures to improve medication adherence in elderly patients with chronic diseases. Methods From September 2023 to December 2023a total of 2 432 residents of three cities in Shandong Province were selected by stratified random sampling according to the economic level and social development. Elderly patients>60 years of agewith chronic diseases and long-term medications were screened according to the inclusion and exclusion criteria. A self-designed Medication Experience Scaleconsisting of 7 dimensions and 28 items was used to investigate the medication experience. A Chinese version of 4-item Medication Adherence Scale was used to investigate the medication adherence. Current status of patients' medication experience and medication adherence were described. Multiple linear regression was performed to analyze the dimensions of medication experience that greatly influenced medication adherence. Results A total of 2 432 questionnaires were distributedand 2 415 valid questionnaires were recoveredwith a valid recovery rate of 99.3%. After excluding samples with missing data on the main variables of the questionnairesa total of 1 544 samples were included in this study. The mean score of medication experience of elderly patients with chronic diseases was 4.310.39 pointwith the highest score in the dimension of life influenced by medication4.720.58pointsand lowest in the dimension of convenience3.860.49points. The mean score of medication adherence in elderly patients with chronic diseases was3.480.619points. A total of 69845.2%patients were identified as a poor adherence. The most common cause for non-adherence was 'forgetting to take medication'77.1%538/698. Medication adherence scores were significantly lower in female elderlyor elderly patients with two or more chronic diseases than those of counterpartsP<0.05. The results of multivariate linear regression showed that medication adherence was worse in female elderly patients=-0.056and elderly patients with two or more chronic diseases=-0.053P<0.05. Among the dimensions of the Medication Experience Scalethe dimensions of effectiveness=0.083and affordability=0.135positively predicted patients' medication adherenceP<0.05. Conclusion The proportion of elderly patients with poor medication adherence to chronic diseases in Shandong Province is 45.2%among whomfemale patients and elderly patients with two or more chronic diseases have a worse medication adherence. The effectiveness and affordability dimensions of the medication experience are positive predictors of medication adherence. Relevant departments should focus on continuously reducing the price of chronic disease medicinesand doctors should strengthen the pharmacy guidance service provided to female patients and elderly patients with two or more chronic diseases.
丰志强、李子源、董平、马东平、时永利、陈钟鸣、尹文强、李晓娜、高敏
10.12114/j.issn.1007-9572.2024.0137
医药卫生理论医学研究方法
慢性病老年人用药体验用药依从性多元线性回归
丰志强,李子源,董平,马东平,时永利,陈钟鸣,尹文强,李晓娜,高敏.老年慢性病患者用药体验对用药依从性的影响分析[EB/OL].(2024-07-29)[2025-08-04].https://chinaxiv.org/abs/202407.00336.点此复制
评论