社区管理老年高血压患者服药不依从的质性研究

A qualitative study on medication non-compliance in elderly patients with hypertension under community management

目的了解社区管理老年高血压患者服药不依从的表现,探讨其服药不依从的影响因素,为基层医疗卫生机构制定干预措施提供依据。方法2018年12月至2019年1月在新疆某市按照最大差异化原则抽样法选取完成Morisky-8服药依从性量表评估且评分<6分的部分老年高血压患者进行半结构式深入访谈,使用Colaizzi七步骤分析法对资料进行分析。结果25例患者Morisky-8服药依从性量表评分中位数为3.25(2.25,4.62)分。遗忘导致的漏服药和根据疾病症状自我调整用药是老年高血压患者最常见的不依从表现。访谈发现用药安全意识薄弱、治疗获益感差、长期用药经济负担重和家庭支持不足是影响社区管理老年高血压患者服药不依从的因素。结论自我调整用药行为在社区管理老年高血压患者中较为常见并受多方面因素的影响,需采取综合的措施进行干预。应加强常见慢性病药物知识教育,提升患者及家属药物素养,鼓励患者及家属参与疾病治疗决策,提高患者治疗获益感,强化家庭和社会支持作用,进而改善服药依从性。

Objective To understand the performance of medication non-compliance in elderly patients with hypertension under community management,to explore the influencing factors of medication non-compliance,and to provide a basis for primary health care institutions to formulate intervention measures.Methods A semi structured in-depth interview was conducted on some elderly patients with hypertension who completed the Morisky-8 Medication Compliance Scale evaluation and the score<6,selected by the maximum differentiation principle sampling method in a certain city of Xinjiang.The data was analyzed by Colaizzi seven-step analysis method.Results The median score of Morisky-8 Medication Compliance Scale for 25 patients was 3.25(2.25,4.62).Missing medication caused by forgetting and self-adjustment of medication according to disease symptoms were the most common performances of non-compliance in elderly patients with hypertension.The interview found that weak awareness of medication safety,poor treatment benefit,heavy economic burden of long-term medication and insufficient family support were the influencing factors of medication non-compliance in elderly patients with hypertension under community management.Conclusion Self-adjustment medication behavior is common in elderly patients with hypertension under community management and is affected by many factors,and needs to be intervened by comprehensive measures.It is necessary to strengthen the education of drug knowledge of common chronic diseases,improve the drug literacy of patients and families,encourage patients and families to participate in disease treatment decisions,improve the patients'sense of benefit,strengthen the role of family and social support,and then improve medication compliance.