上海地区成人哮喘患者治疗依从性的影响因素分析

Influence factors of treatment compliance in adult asthma patients in Shanghai

目的调查上海地区成人哮喘患者的治疗依从性及影响因素。方法采用多中心横断面研究,对上海地区9家医院门诊复诊的成人哮喘患者进行调查。问卷内容包括患者的基本情况、疾病认知、Morisky用药依从性问卷、哮喘药物的使用情况、不遵医嘱用药的原因。根据Morisky评分,将499例使用吸入性糖皮质激素治疗的哮喘患者分为依从性差组(Morisky评分<6)和依从性较好组(Morisky评分≥6分),2组进行比较分析。结果依从性差组为259例(51.9%),依从性较好组为240例(48.1%)。与依从性较好组相比,依从性差组在18~30岁年龄段、专病门诊就诊的人数比例较高(χ^2=6.331、8.983,P值均<0.05),而在50~70岁年龄段、专家门诊就诊的人数比例较低(χ^2=8.088、4.711,P值均<0.05)。依从性差组对第1~5项哮喘知识的知晓率均明显低于依从性较好组(χ^2=19.860、4.711、5.345、27.677、24.975,P值均<0.05)。知晓知识点≤2项的人数比例明显增加(χ^2=18.840,P<0.01)。依从性差组吸入短效支气管扩张剂、联合口服复方甲氧那明、联合中药治疗的人数比例高于依从性较好组(χ^2=6.449、5.208、5.933,P值均<0.05),而且同时使用4种及以上药物的人数比例明显高于依从性较好组(χ^2=20.980,P<0.01)。依从性差组因自觉病情好转、忘记用药、不愿长期采用吸入方式、害怕药物依赖、难以长期坚持、装置使用麻烦而不遵医嘱用药的比例均明显高于依从性较好组(χ^2=59.842、45.303、20.607、18.163、33.659、9.264,P值均<0.01),其因药物疗效差而不遵医嘱的比例亦较高(χ^2=4.452,P<0.05)。结论上海地区成人哮喘治疗依从性不足50%。主要原因包括患者对哮喘长期治疗认知不足、自觉病情好转、忘记用药、不愿长期采用吸入方式等。需采取相应措施提高治疗依从性,达到哮喘良好控制。

Objective To investigate the treatment compliance and influencing factors of adult asthma patients in Shanghai. Methods A multi-center cross-sectional study was conducted to investigate adult asthma patients who were reexamined in outpatient clinics of 9 hospitals in Shanghai.Questionnaires included the basic information of patients, disease awareness, Morisky medication adherence questionnaire, the use of asthma drugs, and the reasons for non-compliance.According to Morisky score, 499 asthmatic patients treated with inhaled glucocorticoids were divided into two groups: the poor compliance group (Morisky score <6) and the better compliance group (Morisky score <6). The two groups were compared. Results There were 259 cases (51.9%) in poor compliance group and 240 cases (48.1%) in better compliance group.Compared with the better compliance group, the poor compliance group had a higher proportion of patients in the 18-30 age group and specialized clinic (χ^2=6.331, 8.983, both P<0.05), while the proportion of patients in the 50-70 age group and expert clinic was lower (χ^2=8.088, 4.711, both P<0.05). The correction rate of the first to fifth items of asthma knowledge in poor compliance group was significantly lower than that in the group with better compliance (χ^2=19.860, 4.711, 5.345, 27.677, 24.975, all P<0.05). And the proportion of patients who knew less than (or equal to) 2 items increased significantly in poor compliance group (χ^2=20.980, P<0.01). Compared with the group with better compliance, the proportion of inhaled short-acting bronchodilator, oral compound methoxyphenamine and traditional Chinese medicine treatment use were higher in the group with poor compliance (χ2=6.449, 5.208, 5.933, all P<0.05). The proportion of patients use more than 4 kinds of medications for treating asthma in poor compliance group was significantly higher than in better compliance group (χ^2=20.980, P<0.01). The proportion of patients in poor compliance group who did not comply with doctor′s advice because of conscious improvement, forgetting medication, unwilling to use inhalation for a long time, fear of drug dependence, difficulty in long-term persistence and troublesome device use was significantly higher than that in better compliance group (χ^2=59.842, 45.303, 20.607, 18.163, 33.659, 9.26, all P<0.01), and the proportion of patients who did not comply with doctor′s advice due to poor drug efficacy was also higher (χ^2=4.452, P<0.05). Conclusions Asthma treatment compliance in Shanghai is less than 50%.The main causes include insufficient awareness of long-term treatment of asthma, Conscious improvement of the condition, forgetting to use drugs, and reluctance to use inhalation for a long time.Corresponding measures should be taken to improve treatment compliance and achieve good control of asthma.