社区老年慢性病患者服药依从性预测模型的构建

Predicting medication adherence in community-dwelling older patients with chronic diseases

目的了解社区老年慢性病患者服药依从性现状,并明确其相关因素,从而为制定行之有效的干预措施,增强其依从性提供参考。方法采用多阶段分层抽样方法,采用中文版8条目Morisky服药依从性问卷对济南市820名社区老年慢性病患者进行评测,基于Andersen行为理论的倾向因素、促成因素和需求因素,构建服药依从性预测模型。结果老年慢性病患者中,242人(29.5%)表现为高服药依从性,314人(38.3%)服药依从性中等,264人(32.2%)服药从性低。单因素分析显示,不同服药依从性的社区老年人在年龄、性别、受教育年限、服药顾虑信念、家庭功能、住院史、自评健康方面的差异有统计学意义(P<0.05);多因素有序Logistic回归分析显示,服药顾虑信念较高(OR=1.215,P<0.001)、家庭功能严重障碍(OR=2.342,P=0.029)且有住院史者(OR=1.385,P=0.042),服药依从性较低;受教育程度(OR=0.962,P=0.048)和服药必要性信念(OR=0.883,P<0.001)高者,依从性较高。结论社区老年慢性病患者总体服药依从性较低,主要影响因素包括倾向因素(受教育程度与服药信念)、促成因素(家庭功能)及需求因素(住院史)。因此,应采取综合干预措施以提高社区老年慢性病患者服药依从性。

Objective To investigate the prevalence and influencing factors of medication adherence in community-dwelling older patients with chronic diseases.Methods A total of 820 community-dwelling older patients with chronic diseases were recruited in Jinan.Medication adherence was assessed by Chinese version of 8-item Morisky Medication Adherence Scale. With application of Andersen Behavioral Model,data were also collected on predisposing characteristics（ social-demographic characteristics and medication beliefs）,enabling resources（ income,health insurance,family function and social support） and need factors（ self-rated health,hospitalization history,the amount of drugs and cognition）.Results The prevalence of good,medium and poor medication adherence was 29.5%,38.3% and 32.2%,respectively. There were significant differences in age,gender,education,medication concerns belief,family function,hospitalization history and self-rated health status among patients with different medication adherence（ P〈0.05）. Ordinal logistic regression analysis demonstrated that patients who had higher medication concerns belief（ OR = 1.215,P〈0.001）,severely impaired family function（ OR = 2.342,P = 0.029） and hospitalization history（ OR = 1.385,P = 0.042） had a higher risk of poorer medication adherence; those who had more formal education（ OR =0.962,P = 0.048） and medication necessity belief（ OR = 0.883,P〈0. 001） showed better medication adherence. Conclusions Medication adherence is poor among older patients,and it is affected by predisposing factors（ education and medication belief）,enabling resources（ family function） and need factors（ hospitalization history）. Therefore,comprehensive interventions are important to improve medication adherence among older patients.