门诊合并虚弱综合征的高血压老年患者对口服降压药物依从性的影响因素分析

Study on the effects of oral hypotensivc compliance in eIderly patients with frailty syndrome

目的调查合并虚弱综合征的高血压老年患者与口服降压药物依从性的关系。方法随机抽取2015年3月至2017年3月来大连医科大学附属第一医院心内科门诊就诊的临床确诊为原发性高血压的老年患者200例。每个患者均记录一般情况。每个患者均评估虚弱量表(TFI),健康行为量表(HBI)以及药物依从性量表(MMAS-8)评分。将人口变量以及TFI分别作为自变量,将MMAS-8评分与HBI评分作为因变量,评估每个自变量与每个因变量的线性相关。将上述自变量作为协变量,做无序多分类Logistic回归分析校正后的结果。结果200例患者年龄(73.5±7.5)岁,其中女103例(51.5%,103/200),男97例(48.5%,97/200),高血压病史为(12.5±6.1)年,高血压治疗方式单单药物治疗74例(37%,74/200),多药物治疗126例(63%,126/200)。TFI平均值为(4.3±3.0)分,其中身体因素、心理因素及社会因素平均得分分别为(7.6±3.1)、(3.9±2.0)、(1.42±0.9)分,HBI平均值为(3.3±0.3)分,其中健康饮食习惯,预防保健,积极的心态和健康行为平均得分分别为(3.3±0.8)、(3.3±0.4)、(3.4±0.5)、(3.4±0.5)分。MMAS-8平均值为:(5.2±2.0)分,其中低依从性患者数为144例(72%,144/200),中度依从性患者数为38(19%,38/200),高度依从性患者数为18例(9%,18/200)。单因素线性相关性分析结果:年龄(Rho:-0.443),高血压病史(r=-0.421),TFI评分(Rho:-0.483)与药物依从性呈负相关(P<0.05)。已婚/同居患者(tau_b:0.293),受教育程度(tau_b:0.391),月收入(tau_b:0.398)与药物依从性呈正相关,其中后两者与药物依从性呈正相关(P<0.01)。月收入(tau_b:0.371)与HBI呈正相关,TFI评分(Rho:-0.364)与HBI呈负相关,P<0.01。Logistic回归分析结果提示:教育程度是药物依从性(MMAS-8)积极决定因素(B=0.81,P=0.01),月收入是健康行为(HBI)的积极决定因素。虚弱综合征(TFI)是药物依从性差(B=-0.11,P<0.01)和健康行为差(B=-0.71,P=0.03)的负向决定因素。结论虚弱综合征是一个重要的预测药物依从性和遵守健康行为的独立因素,受教育程度高提高了患者药物的依从性,良好的财务状况能够使患者更积极的遵守健康行为。

Objective To investigate the relationship between elderly hypertension patients with frailty syndrome and oral medication compliance.Methods Two hundred elderly patients with hypertensionwho visited the department of cardiology of the First Hospital Affiliated to Dalian Medical University from March 2015 to March 2017were randomly selected. General information was recorded for each patient. The Tilburg Frailty Indicator (TFI), Healthy behavior inventory (HBI) and medication adherence inventory (mmas-8) were assessed for each patient. The population variable and TFI were taken as independent variables, and the mmas-8 score and HBI score were taken as dependent variables to evaluate the linear correlation between each independent variable and each dependent variable. The above independent variables were used as covariates and the Results were corrected by disordered multiple Logistic regression analysis.Results The average age of 200 patients was (73.5±7.5) years old, including 103 women (51.5%, 103/200), 97 males (48.5%, 97/200), and the average medical history of hypertension was (12.5±6.1) years. There were 74 patients (37%, 74/200) and 126 patients (63%, 126/200). The mean TFI was 4.3±3.0. The average scores of physical, psychological and social factors were 7.6±3.1, 3.9±2.0, 1.4±0.9, and the average HBI was 3.3±0.3. Among them, the average scores of healthy eating habits, preventive health care, positive mentality and healthy behavior were 3.3±0.8, 3.3±0.4, 3.4±0.5, and 3.4±0.5, respectively. The mean MMAS-8 was 5.2±2.0, with 144 patients (72%, 144/200) with low compliance and 38 (19%, 38/200) with moderate compliance. Age (Rho: -0.443), history of hypertension (r:-0.421), TFI score (Rho:-0.483) were negatively correlated with drug adherence (P<0.05). Married/cohabiting patients (tau_b: 0.293), education level (tau_b:0.391), monthly income (tau_b: 0.398) were positively correlated with drug compliance, and the latter two were significantly positively correlated with drug compliance (P<0.01). Monthly income (tau_b:0.371) was significantly positively correlated with HBI, and TFI score (Rho: -0.364) were significantly negatively correlated with HBI, P<0.01. Logistic regression analysis suggested that education degree was a positive determinant of drug compliance (mmas-8) (B=0.81,P=0.01), and monthly income was a positive determinant of health behavior (HBI). Frailty syndrome (TFI) is a negative determinant of poor drug adherence (B=-0.11, P<0.01) and poor health behavior (B=-0.71, P=0.03).Conclusion s Frailty syndrome is an important independent factor in predicting drug adherence and adherence to healthy behaviors. High education level improves patient compliance, and good financial status can make patients more active in adherence to healthy behaviors.