冠心病二级预防中他汀类药物用药依从性的影响因素分析及其预防对策

Influencing Factors of Statins Medication Compliance in the Secondary Prevention for Coronary Heart Disease and Its Countermeasures

目的分析冠心病(CHD)二级预防中他汀类药物用药依从性的影响因素及其预防对策。方法选取2012—2014年于江苏省南通大学附属医院分院就诊并采用他汀类药物进行二级预防的CHD患者140例,按他汀类药物用药依从性评价标准将CHD患者分为依从性好组90例及依从性差组50例。分析年龄、性别、受教育程度、婚姻状况、家庭支持、居住地、月收入、二级预防知识、他汀类药物不良反应、医疗费用支付方式、复诊条件等因素对患者用药依从性的影响。结果两组患者年龄、受教育程度、家庭支持、居住地、月收入、二级预防知识、他汀类药物不良反应、医疗费用支付方式、复诊条件比较,差异有统计学意义(P<0.05);两组患者性别及婚姻状况比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,年龄≥70岁〔OR=4.50,95%CI(1.23,30.14)〕、居住地为农村〔OR=2.80,95%CI(2.02,17.49)〕、缺乏二级预防知识〔OR=3.97,95%CI(2.08,28.27)〕、担心他汀类药物不良反应〔OR=3.32,95%CI(1.90,22.45)〕是CHD患者他汀类药物用药依从性差的独立危险因素(P<0.05)。结论年龄≥70岁、居住地为农村、缺乏二级预防知识、担心他汀类药物不良反应是CHD患者他汀类药物用药依从性差的独立危险因素,医务工作者应多关心老年患者,加大对患者CHD二级预防知识的宣教力度,普及他汀类药物不良反应较少的相关知识,以减少患者不按时服药情况以及长期用药的抵触心理,从而更好地实施CHD二级预防。

Objective To explore the influencing factors of statins medication compliance in the secondary prevention for coronary heart disease and its countermeasures. Methods Between 2012 and 2014 in the Branch of Affiliated Hospital of Nantong University,a total of 140 coronary heart disease patients received statins for secondary prevention were enrolled in this sturdy. According to the statins medication compliance evaluation criterion, the 140 patients were divided into A group（ with good medication compliance,n = 90） and B group（ with poor medication compliance,n = 50）. The influence of age,gender,educational level, marital status, family property support, place of residence, monthly income, secondary prevention knowledge,statins adverse reactions,payment method of medical expenses, subsequent visit conditions on statins medication compliance was analyzed. Results There were statistically significant differences of age, educational level, family property support,place of residence,monthly income,secondary prevention knowledge,statins adverse reactions,payment method of medical expenses,subsequent visit conditions between the two groups（ P〈0. 05）,while no statistically significant differences of gender or marital status was found between the two groups（ P〈0. 05）. Multivariate Logistic regression analysis showed that,age equal or over 70 years old 〔OR = 4. 50,95% CI（ 1. 23,30. 14） 〕,living in countryside 〔OR = 2. 80,95% CI（ 2. 02,17. 49） 〕, lack of secondary prevention knowledge 〔OR = 3. 97,95% CI（ 2. 08,28. 27） 〕, worry about statins adverse reactions 〔OR = 3. 32,95% CI（ 1. 90,22. 45） 〕 were independent risk factors of poor statins medication compliance of coronary heart disease patients（ P〈0. 05）. Conclusion Age equal or over 70 years old, living in countryside, lack of secondary prevention knowledge, worry about statins adverse reactions are independent risk factors of poor statins medication compliance of coronary heart disease patients; medical worker should pay more attentions to the aged patients,strengthen the propaganda and education of secondary prevention knowledge for coronary heart disease,popularize the knowledge about mild statins adverse reactions,in order to reduce the incidence of unregularly taking medicine and conflict psychology for long-term taking medicine,to preferably carry out the secondary prevention for coronary heart disease.