聚焦解决模式在缺血性脑卒中患者服药依从性中的应用

Application of solution-focused approach on medication adherence in patients with cerebral ischemic stroke

目的探讨聚焦解决模式在缺血性脑卒中患者服药依从性中的应用效果。方法选取2019年5—8月哈尔滨医科大学附属第二医院住院的缺血性脑卒中患者120例,按随机数字表法分为对照组和试验组,每组60例。对照组患者接受院内常规护理及院外延续护理,试验组患者在对照组基础上接受聚焦解决模式的护理干预。应用服药依从性量表(MMAS-8)、服药信念量表(BMQ)、Richard Gray服药依从信心和服药依从意愿评分法以及血压值的变化评价2组的干预效果。结果最终对照组纳入57例,试验组纳入58例。干预前2组服药依从性得分比较差异无统计学意义(P>0.05),对照组和试验组干预后1个月分别为(5.110±1.194)、(6.160±1.064)分,干预后3个月分别为(5.044±1.010)、(6.306±0.685)分,差异有统计学意义(t=4.98、7.83,均P<0.05)。2组干预前服药信念得分、服药依从信心得分、服药依从意愿得分、收缩压及舒张压比较差异无统计学意义(P>0.05),对照组和试验组干预后1个月分别为(2.561±2.605)分、(7.123±1.310)分、(6.368±1.234)分、(131.86±13.13)mmHg(1 mmHg=0.133 kPa)、(84.33±7.05)mmHg和(4.345±3.006)分、(7.603±1.388)分、(6.948±1.527)分、(126.52±12.44)mmHg、(83.95±8.07)mmHg,干预后3个月分别为(1.667±2.149)分、(6.737±1.218)分、(5.702±1.362)分、(130.47±13.77)mmHg、(84.25±7.71)mmHg和(4.879±2.760)分、(7.793±1.321)分、(7.207±1.373)分、(125.71±11.18)mmHg、(82.98±7.41)mmHg;干预后1、3个月试验组服药信念得分、服药依从意愿得分高于对照组,收缩压低于对照组,干预后3个月试验组服药依从信心得分高于对照组,差异有统计学意义(t值为-2.24~6.96,均P<0.05)。重复测量方差分析显示,服药依从性、服药信念、服药依从信心、服药依从意愿以及收缩压的组间效应与时间效应间存在交互作用(F值为12.81~26.17,均P<0.05)。结论聚焦解决模式能显著提高缺血性脑卒中患者的服药依从性、服药信念、服药依从信心及服药依从意愿,并有效控制血压波动。

Objective To explore the effect of solution-focused approach on medication adherence in patients with cerebral ischemic stroke.Methods A total of 120 patients with cerebral ischemic stroke from May to August 2019 in the Second Affiliated Hospital of Harbin Medical University were divided into the experimental group and the control group by random digits table method with 60 cases in each group.The patients in the control group received the routine nursing in the hospital and extended nursing outside the hospital,while patients in the experimental group received the solution-focused approach based on the control group.The intervention effects of the two groups were evaluated by Morisky Medication Adherence Scale(MMAS-8),Beliefs about Medication Questionnaire(BMQ),Richard Gray's scoring method of medication compliance confidence and willingness to take medication,and the changes of blood pressure.Results Finally,57 cases were included in the control group and 58 cases in the experimental group.There was no significant difference in the scores of medication compliance between the two groups before intervention(P>0.05).The scores of the control group and the experimental group were 5.110±1.194,6.160±1.064 at 1 month after intervention and 5.044±1.010,6.306±0.685 at 3 months after intervention,the differences were statistically significant(t=4.98,7.83,both P<0.05).There was no significant difference in medication belief score,medication compliance confidence score,willingness to take medication score,systolic blood pressure and diastolic blood pressure between the control group and the experimental group before intervention(P>0.05).One month after intervention,those index mentioned above were(2.561±2.605)points,(7.123±1.310)points,(6.368±1.234)points,(131.86±13.13)mmHg(1 mmHg=0.133 kPa),(84.33±7.05)mmHg in the control group,and(4.345±3.006)points,(7.603±1.388)points,(6.948±1.527)points,(126.52±12.44)mmHg,(83.95±8.07)mmHg in the experimental group.Three months after intervention,those index mentioned above were(1.667±2.149)points,(6.737±1.218)points,(5.702±1.362)points,(130.47±13.77)mmHg,(84.25±7.71)mmHg in the experimental group,and(4.879±2.760)points,(7.793±1.321)points,(7.207±1.373)points,(125.71±11.18)mmHg,(82.98±7.41)mmHg in the control group.One month and three months after intervention,the scores of medication belief and willingness to take medication in the experimental group were higher than those in the control group,and the systolic blood pressure was lower than that in the control group.Three months after interevention,medication compliance confidence was higher than that in the control group.The differences were statistically significant(t values were-2.24-6.96,all P<0.05).Repeated measurement analysis of variance showed that there were interactions between the group effect and time effect of medication compliance,medication belief,medication compliance confidence,willingness to take medication and systolic blood pressure(F values were 12.81-26.17,all P<0.05).Conclusions Solution-focused approach can significantly improve patients'medication adherence,beliefs about medication,medication compliance confidence,willingness to take medication,and effectively control blood pressure fluctuations.