高血压患者自我管理行为与服药依从性的关联

The association between self-management behaviors and medication adherence in patients with hypertension

目的了解高血压患者自我管理行为和服药依从性现状,分析自我管理行为与服药依从性的关联。方法在北京市顺义区8个社区卫生服务中心募集高血压患者596例,使用问卷进行横断面调查,问卷内容包括人口统计学特征、高血压基本情况、自我管理行为(包含有意识限盐、食用腌制食品、蔬菜摄入、30min身体活动、体育锻炼、吸烟、饮酒和生气发火8个条目)及Morisky服药依从性量表。结果全部患者中高服药依从性(Morisky服药依从性评分为8分)的比例为31.9%(190/596,95%CI28.1%~35.6%)。体育锻炼方面的自我管理行为得分较低,中位数(P25~P75)为1(0~7)分。趋势χ2检验发现年龄、高血压服药年限与服药依从性有线性趋势(年龄χ2=9.767,服药年限χ2=10.295,均P<0.05);Mann-Whitney U秩和检验发现女性患者在有意识限盐、食用腌制食品、30min身体活动、吸烟、饮酒以及总体自我管理行为方面好于男性(P<0.05);Kruskal-Wallis H秩和检验发现食用腌制食品(Hc=6.443,P=0.040)、30min身体活动(Hc=6.432,P=0.040)、生气发火(Hc=8.472,P=0.014)与服药依从性有关。服药依从性的有序多分类Logistic回归分析发现,年龄≥60岁的患者相对于年龄<50岁的患者具有更高的服药依从性(OR=1.919,95%CI1.089~3.387),医保为城镇职工和公费医疗的患者相对于新农合的患者具有更高的服药依从性(OR=1.910,95%CI1.228~2.968),服药年限为10~<20年的患者相对于<5年的患者具有更高的服药依从性(OR=1.839,95%CI 1.231~2.748),1周内生气发火天数越少的患者服药依从性越高(OR=1.112,95%CI1.018~1.215)。结论高血压患者的自我管理行为,尤其是高盐膳食、身体活动、情绪管理与服药依从性关系密切,需要对患者进行生活方式和药物治疗的综合干预。

Objective To investigate the current situation and the association of self-management behaviors with medication adherence in patients with hypertension. Methods A total of 596 hypertensive patients were enrolled from eight community health service centers in Shunyi District of Beijing. The cross-sectional survey was conducted by a questionnaire, which covered demographic characteristics, the basic situation of hypertension, self-management behaviors （containing 8 items： intentionally limiting salt, pickled foods consumption, vegetables intake, 30 minutes of physical activity, physical exercise, smoking, drinking and getting angry） and Morisky medication adherence scale. Results The proportion of high medication compliance （Morisky medication compliance score was 8 points） was 31.9% in all the patients （190/596, 95% CI 28. 1% --35.6%）. The score of self-management behavior on physical exercise was at a low level, and the median （P25 --P75 ） was 1 （0-7） point. The associations of age and duration of medication with medication adherence showed significant linear trends according to the trend Chi-square test （age X2= 9. 767, duration of medication X2=10. 295,both P〈0.05）. The Mann-Whitney U test showed that compared to male patients, female patients had better self-management behaviors, including intentionally limiting salt,eating pickled foods, 30 minutes of physical activity, smoking, alcohol drinking and total scores （P=0.05}. Eating pickled foods （He =6. 443, P〈0. 040）, 30 minutes of physical activity （Hc=6. 432, P=0. 040} and getting an- gry { Hc = 8. 472, P= 0. 014） were related to medication adherence according to the Kruskal-Wallis H test. The or- dinal ptoytomous logistic regression analysis revealed that the patients aged 60 years and older had higher medication adherence than those aged 49 years and younger （OR=I. 919, 95% CI 1. 089--3. 387）, the patients who participa- ted in the socialized medicine and urban employees basic medical insurance system had higher medication adherence than those who participated in the new-type rural cooperative medical scheme {OR = 1. 910, 95% CI 1. 228- 2. 968）, the patients with 10--%20 years of medication duration had higher medication adherence than those with less than 5 years of medication duration （ OR = 1. 839, 95 % CI 1. 231 -- 2. 748 ）, and the patients who experienced less number of getting angry days in one week had higher medication adherence {OR= 1. 112, 95% CI 1. 018-- 1. 215}. Conclusion Selmanagement behaviors, especially high salt diet, physical activity and emotion management had close relationships with medication adherence in patients with hypertension, and comprehensive interven- tion in patients＂ lifestyle and medicine treatment was needed.