门诊新发高血压患者服药依从性轨迹及影响因素研究

Medication adherence trajectory and its influencing factors in outpatients with new-onset hypertension

目的探究门诊新发高血压患者服药依从性轨迹及其影响因素,为制定针对性干预措施提供参考。方法采用便利抽样法选取337例门诊新确诊的高血压患者为研究对象,应用Morisky服药依从性量表于确诊后4周、3个月、6个月和12个月进行4次调查,采用群组化轨迹模型分析患者服药依从性变化轨迹,并通过多分类logistic回归分析其影响因素。结果患者在4个时间点的服药依从性得分比较,差异无统计学意义(P>0.05)。服药依从性轨迹分为持续高依从性组(52.82%)、中等波动组(37.09%)及持续低依从性组(10.09%)3类。多分类logistic回归分析显示,与持续高依从组相比,年龄51~60岁、服药种类≥3种更易进入中等波动组(均P<0.05),年龄36~50岁、文化程度大专、家庭人均月收入<1000元更易进入持续低依从性组,社会支持有利于提高患者服药依从性(均P<0.05)。结论门诊新发高血压患者在确诊12个月内服药依从性轨迹呈现相对稳定性特征,但存在显著的群体异质性。医护人员应特别关注持续低服药依从性及依从性波动变化的患者,根据影响因素采取针对性干预措施,以提高患者服药依从性。

Objective To explore the trajectory of medication adherence and its influencing factors in outpatients with new-onset hypertension,so as to provide a reference for developing targeted intervention.Methods A total of 337 newly diagnosed outpatients with hypertension were selected by convenience sampling method,then they were investigated by utilizing the Morisky Medication Adherence Scale(MMAS-8)at 4 weeks,3 months,6 months and 12 months after diagnosis.The group-based trajectory modeling was used to analyze the participants′medication adherence trajectory,and its influencing factors were explored by utilizing multinomial logistic regression.Results There was no statistically significant difference in the participants′scores of MMAS-8 at 4 time points(P>0.05).The medication adherence trajectory was divided into three categories:a continuous high adherence group(52.82%),a moderate fluctuation group(37.09%)and a continuous low adherence group(10.09%).Multivariate logistic regression analysis showed that,compared with the continuous high adherence group,the patients with an age of 51-60 years old and taking three kinds or more medications were more likely to enter into the moderate fluctuation group(both P<0.05),and the patients with an age of 36-50 years old,educational background of junior college,and per capital monthly income of the family less than 1000 yuan were prone to enter into the continuous low adherence group,and social support was conducive to improving patients′medication adherence(all P<0.05).Conclusion The medication adherence trajectory in outpatients with new-onset hypertension shows relatively stable characteristics within the first 12 months after diagnosis,but it reveals significant group heteroge-neity.Medical staff should pay special attention to those patients with continuous low medication adherence and fluctuating adhe-rence,and take targeted interventions according to the influencing factors,so as to improve their medication adherence.