西安地区阿尔茨海默病病人药物依从性调查及影响因素分析

Investigation and analysis of influencing factors of the medication adherence in patients with Alzheimer’s disease in Xi’an

目的调查西安地区AD病人服用指南推荐药物(多奈哌齐、加兰他敏、卡巴拉汀及美金刚)的依从性现状,分析其影响因素。方法选取2016年5月至2021年4月在西安交通大学第一附属医院记忆门诊就诊的473例AD病人为研究对象,收集临床资料并将其分为依从性好组和依从性差组,比较2组人口学资料、首诊资料及照料者的基本情况等,使用多因素Logistic回归分析AD病人服药依从性的影响因素。结果473例病人中,1年依从性差的病人为213例,占45.0%。2组病人之间居住地、教育程度、医保类型、MMSE评分、精神行为症状、联合用药、每月药费、照料者的教育程度、照料者的职业及家庭人均月收入差异有统计学意义(P<0.05)。照料者认为治疗无明显效果是停药最主要的原因。多因素Logistic回归分析显示,影响药物依从性的因素包括:照料者职业(OR=0.405,95%CI:0.266~0.616,P<0.001)、MMSE评分(OR=1.071,95%CI:1.030~1.115,P=0.001)、精神行为症状(OR=0.660,95%CI:0.436~1.000,P=0.049)、联合用药(OR=0.389,95%CI:0.250~0.606,P<0.001)。结论西安地区AD病人药物依从性差的现象有待改善,照料者对待疾病的态度、疾病严重程度及用药策略是影响药物依从性的主要因素。

Objective To investigate the status of medication adherence in the patients with Alzheimer’s disease(AD)taking guideline-recommended drugs(donepezil,galantamine,rivastigmine,and memantine)in Xi’an,and to analyze the influencing factors.Methods From May 2016 to April 2021,a total of 473 AD patients from the Memory Clinic of the First Affiliated Hospital of Xi’an Jiaotong University were selected and divided into the good adherence group and the poor adherence group.The demographic data,first visit data and basic information of caregivers in the two groups were observed and compared.Multivariate Logistic regression analysis was performed to analyze the influencing factors of medication adherence in the AD patients.Results Of the 473 patients,45.0%had poor 1-year adherence.There were significant differences in the residence,education degree,medical insurance type,score of Mini-Mental State Examination(MMSE),mental behavior symptoms,drug combination,monthly drug costs,education degree of caregivers,occupation of caregivers and the monthly family income between the good adherence group and poor adherance group(P<0.05).Caregivers believing that the treatment showed no significant effect was the most important reason for discontinuation.Multivariate Logistic analysis showed that the influencing factors of medication adherence included caregivers’occupation(OR=0.405,95%CI:0.266-0.616,P<0.001),MMSE score(OR=1.071,95%CI:1.030-1.115,P=0.001),psycho-behavioral symptoms(OR=0.660,95%CI:0.436-1.000,P=0.049),and drug combination(OR=0.389,95%CI:0.250-0.606,P<0.001).Conclusions It is important to improve the poor medication adherence in AD patients in Xi’an.The attitude of caregivers to the disease,the sever degree of the disease,and the drug strategies are the main factors affecting medication adherence.