社区精神分裂症患者服药依从性调查及影响因素分析

Investigation of medication compliance and influencing factors of patients with schizophrenia in community

目的探讨社区精神分裂症患者服药依从性及影响因素。方法对上海市虹口区8个街道社区卫生服务中心登记在册的精神分裂症患者服药依从性情况进行问卷调查,运用二元Logistic回归方法分析影响患者服药依从性的因素。结果入组的2342例社区精神分裂症患者中,服药依从性好者为2159例(占92.2%),服药依从性差者为183例(占7.8%)。Logistic回归分析结果显示起病形式缓慢(OR=2.230,95%CI:1.374~3.619,P=0.001)、自知力不全(OR=6.027,95%CI:1.769~20.533,P=0.004)或缺失(OR=9.306,95%CI:2.146~40.360,P=0.003)、病情严重程度评分>10分(OR=3.229,95%CI:1.765~5.910,P<0.001)、就诊方式为未门诊(OR=15.413,95%CI:5.912~40.180,P<0.001)、不定期复诊(OR=19.838,95%CI:11.914~33.032,P<0.001)、监护情况差(OR=2.156,95%CI:1.402~3.318,P<0.001)、近期有心理生活应激事件(OR=9.112,95%CI:2.854~29.085,P<0.001)为社区精神分裂症患者服药依从性的不利因素。结论社区精神分裂症患者服药依从性的影响因素包括患者的起病形式、自知力、病情严重程度、就诊方式、复诊及时性、监护情况和近期心理生活应激事件,需针对性采取干预措施以提高社区精神分裂症患者服药依从性。

Objective To explore medication compliance and the related factors of patients with schizophrenia in the community.Methods The schizophrenic patients registered in 8 community health service centers in Hongkou District of Shanghai were selected to investigate the medication compliance by questionnaire.A binary logistic regression method was applied to analyze related factors of medication compliance.Results Of 2342 patients with schizophrenia in the community,2159 cases(92.2%)had good medication compliance,183 cases(7.8%)had poor medication compliance.The binary logistic regression analysis showed the unfavorable factors of medication compliance of schizophrenics in community included slow onset,incomplete insight or ignorance,disease severity score>10,no outpatient service,irregular visiting clinic,poor guardianship,and the occurrence of recent psychological and life stress events(OR=2.230,OR=6.027,OR=9.306,OR=3.229,OR=15.413,OR=19.838,OR=2.156,OR=9.112,allP<0.05).Conclusions The influencing factors of medication compliance of schizophrenics in community included the type of onset,insight,disease severity,method of visiting clinic,regular follow-up or not,guardianship,and recent psychological and life stress events.The effective intervention should be taken to improve the medication compliance of patients with schizophrenia in the community.