青光眼患者局部用药依从性及影响因素的调查

The survey of compliance with topical hypotensive therapy and its determinants in patients with glaucoma

目的调查使用局部降眼压药物的青光眼患者的用药依从性及影响因素，为更好地使用青光眼药物提供有用的信息。设计问卷调查。研究对象北京同仁医院就诊的（门诊和病房）使用局部降眼压药物治疗的青光眼患者236例。方法面对面问卷调查。将没有严格按照医生处方要求用药定义为不依从。调查青光眼患者局部用药总体不依从率，及不同人口社会环境因素、不同青光眼认知水平及青光眼治疗方面等各个因素的依从率，χ2检验和Logistic回归统计分析不依从率的相关影响因素。主要指标不依从率及相关因素。结果236例局部用药的青光眼患者完成问卷调查，总体不依从率62.3％，联合用药的患者占大多数（83．0％）。最常见的不依从原因是忙或忘记（61．9％），其次是离家外出不方便用药（14．3％）。青光眼患者局部用药依从性与发病时症状的轻重、用药持续时间以及是否每天在固定时间用药有显著相关性（P均〈0．05）；与年龄、性别、文化程度、经济状况、青光眼类型及病情轻重、认知程度、用药种类、用药次数、是否有人提醒用药、是否独居以及是否患有其他疾病等因素无关。结论所调查的青光眼患者使用局部降眼压药物治疗的依从性较差，症状轻、长期用药及没有固定的用药时间的患者更易出现不依从。

Objective To assess the prevalence of compliance with topical hypotensive therapy in patients with glaucoma, and identify potential determinants of noncompliance. Design Questionnaire. Participants Glaucoma patients with eye drop therapies in Beijing Tongren Hospital. Methods One-on-one interview and questionnaire. Data collected included demographics, understanding of glaucoma, symptom and type of glaucoma, clinical examinations and treatment status. Definition of noncompliance is that the patient＇s actual dosing history was not strictly corresponding with the prescribed treatment regimen. χ2 test and logistic regression analysis was performed to identify the determinants of noncompliance. Main Outcome Measures The proportion of noncompliers and determinants of noncompliance. Results The proportion of noncompliers was 62.3% in 236 glaucoma patients with eye drop therapies. Most patients were combined medication （83.0%）. The most common reason of noncompliance was busy or forgetting dose （61.9%）; the second was inconveniently dose especially when going out. Factors significantly influencing compliance included symptom, duration of medication and whether to administrate on the same time daily. Age, gender, education level, economic status, type and severity of glaucoma, understanding of glaucoma, type of eye drop, frequency of dose, with or without reminder, a single life, suffering from other diseases with medication were not associated with a higher rate of non-compliance. Conclusions Noncompliance with hypotensive treatment is common in glaucoma patients interviewed. The patients with mild symptom, perennial medication or no-fixed time dose tend to non-compli- ance.