河北省南和县农村卒中患者二级预防药物依从性及其相关因素分析

Secondary Prevention Medications Adherence and Related Factors among Stroke Survivors in Rural Area of Nanhe County,Heibei Province

目的分析河北省南和县农村卒中患者应用二级预防抗血小板药物、他汀类药物和降压药物的服药依从性现状,并探讨其影响因素。方法本研究使用群组随机对照试验“南和县实用创新型脑卒中防治项目”的基线调查数据。该横断面调查于2017年7月抽取位于5个镇的50个村,每村抽取符合纳入和排除标准的卒中患者开展问卷调查及体格检查。问卷主要信息包括:社会人口学信息、患病史、社会支持、服药依从性等。患者服药依从性根据Morisky Green Levine量表评测。采用多因素Logistic回归分析法分析患者抗血小板药物、他汀类药物和降压药物服药依从性的影响因素。结果共纳入1299例卒中患者,平均年龄65.7±8.2岁,男性746例(57.4%)。服用抗血小板类、他汀类、降压药物的患者分别占依照诊断史估测应服药人数的72.0%(852/1184)、28.4%(340/1197)和91.1%(1030/1131)。服药患者中,药物依从率分别为63.0%(537/852)、63.5%(216/340)和62.6%(645/1030)。多因素分析显示,自我感知照护需求低的患者(OR 0.58,95%CI 0.45~0.75,P<0.001),服用抗血小板药物依从性好;有卒中复发史患者(OR 2.09,95%CI 1.17~3.71,P=0.013)服用他汀类药物依从性差,无吸烟史患者(OR 0.43,95%CI 0.19~0.97,P=0.043)服用他汀类药物依从性好。年龄较大(OR 0.97,95%CI 0.95~0.99,P=0.004)、服2种以上药物(OR 0.54,95%CI 0.39~0.75,P<0.001)、自我感知照护需求低(OR 0.58,95%C I 0.40~0.84,P=0.004)及无吸烟史患者(OR 0.63,95%CI 0.41~0.84,P=0.046)服用降压类药物依从性好。结论河北省南和县农村卒中患者二级预防合理用药率较低,服药患者依从性不佳,服药依从性与患者年龄、吸烟史、卒中复发史、服药数量、自我感知照护需求等因素相关。

Objective To assess the adherence to secondary prevention medications(antiplatelet drugs,statins,and antihypertensive drugs)among individuals with a history of stroke in rural China,and analyze the related factors of medications adherence.Methods The baseline survey data were analyzed from multi-center cluster-randomized controlled trial“Nanhe County Practical and Innovation Stroke Prevention Project”.This survey conducted in July 2017 was a cross-sectional survey enrolled eligible stroke patients from 50 villages of 5 townships,Nanhe County.The self-report questionnaire survey and physical examination were conducted in all patients.The main information of the questionnaire included socio-demographic information,medical history,social support,and medication compliance,etc.Medication adherence was measured by the Morisky Green Levine scale.Multivariate logistic regression was conducted to analyze the related factors of the persistence of antiplatelet drugs,statins,and antihypertensive drugs.Results A total of 1299 stroke patients were included in this analysis,with a mean age of 65.7±8.2 years old and 746(57.4%)males.Participants who were actually taking antiplatelet drugs,statins and antihypertensive drugs accounted for 72.0%,28.4%,and 91.1%of the estimated population who should take the corresponding drugs according to the disease diagnosis.Among those who were taking medicines,63.0%,63.5%,and 62.6%had good adherence to antiplatelet drugs,statins and antihypertensive drugs.Multivariate analysis showed that less self-perceived care needs was associated with better adherence to antiplatelet drugs(OR 0.58,95%CI 0.45-0.75,P<0.001);stroke recurrence was associated with worse adherence to statins(OR 2.09,95%CI 1.17-3.71,P=0.013),and no-smoking was associated with better adherence to statins(OR 0.43,95%CI 0.19-0.97,P=0.043);elder age(OR 0.97,95%CI 0.95-0.99,P=0.004),taking more than one kind of medicine(OR 0.54,95%CI 0.39-0.75,P<0.001),less self-perceived care need(OR 0.58,95%CI 0.40-0.84,P=0.004),and no-smoking(OR 0.63,95%CI 0.41-0.84,P=0.046)were associated with better adherence to antihypertensive drugs.Conclusions There were relatively low rate of rational use of secondary prevention drugs and poor compliance of treatment among stroke patients in Nanhe County,Hebei Province.Age,smoking,stroke recurrence,taking more than one kind of medicine,less self-perceived care needs were associated with secondary prevention medications adherence.