社区老年人合理用药管理模式对患者用药知信行的影响研究

The Influence of Rational Drug Use Management Mode of the Elderly in Community on Patients' Knowledge,Attitude and Practice of Drug Use

背景随着人口老龄化进程加快,老年人共病和多重用药问题严重,社区卫生服务中心成为老年人获取各类健康服务的重要途径,然而基层医疗卫生机构对老年患者的用药管理仍处在薄弱状态。目的探讨社区老年人合理用药管理模式对患者用药知信行的影响,为改善老年人用药行为提供现实依据。方法于2021年9—12月,选择上海市金山区2家社区卫生服务中心作为样本来源地,以已签约家庭医生的老年慢性病共病患者为研究对象。随机选取其中1家社区卫生服务中心的已签约老年患者为干预组(n=223),以另一家社区卫生服务中心的已签约老年患者为对照组(n=198)。采用倾向性匹配得分(PSM)以1∶1比例进行组间基线匹配。对照组患者采用常规慢性病管理方案,对干预组患者进行药物整合,指导患者在用药过程中使用《老年人用药保健手册》及分装药盒,开展社区老年人合理用药管理模式。记录患者入组时和随访3个月后的用药知信行得分和规范用药行为情况,并分析干预前后变化情况。结果经过PSM后,共有141对匹配成功,匹配后干预组与对照组基本情况比较,差异无统计学意义(P>0.05)。干预后,干预组患者合理用药知识、信念、用药依从性得分、规范用药习惯养成情况与干预前比较,差异有统计学意义(P<0.05);干预后,干预组患者合理用药知识、信念、用药依从性得分高于对照组合理用药知识、信念、用药依从性得分,差异有统计学意义(P<0.05);干预后,干预组患者建立用药提醒习惯、将药物放在显眼位置、家属参与协助提醒服药、使用分装药盒和记录用药笔记的比例均高于对照组,差异具有统计学意义(P<0.05)。结论社区老年人合理用药管理模式有助于强化家庭医生团队服务,增强患者合理用药知识信念,提高患者用药行为依从性和规范性。

Background With the acceleration of population aging,the problem of multi-drug comorbidity among the elderly is serious,and community health service centers have become an important way for the elderly to obtain various health services.However,the management of medication for elderly patients in primary health care institutions is still in a weak state.Objective To explore the influence of the rational medication management model on patients' knowledge,belief and behavior of medication in the community elderly,and to provide a realistic basis for improving the medication behavior of the elderly.Methods From September to December 2021,two community health centers in Jinshan District,Shanghai were selected as the sample source,elderly patients with chronic disease comorbidity with contracted general practitioner were studied.The contracted elderly patients from one of the community health service centers were randomly selected as the intervention group(n=223),and the contracted elderly patients from another community health service center were selected as the control group(n=198).Baseline matching between groups was performed using a propensity matching score(PSM)in a 1 ∶ 1 ratio.Patients in the control group adopted the conventional chronic disease management plan,patients in the intervention group were medicationintegrated and instructed to use the Health Care Handbook of Medication for the Elderly and split pill boxes during medication administration,implementing a rational drug use management mode of the elderly in community.The patients' medication knowledge,belief and behavior scores and standardized medication use behaviors at enrollment and after 3 months of followup were recorded,and changes before and after the intervention were analyzed.Results After PSM,a total of 141 pairs were successfully matched,and the difference between the basic situation of the intervention group and the control group after matching was not statistically significant(P>0.05).After the intervention,the difference between the patients' knowledge of rational medication,belief,medication adherence score,and the development of standardized medication habits in the intervention group was statistically significant compared with the pre-intervention situation(P<0.05).After the intervention,the patient's knowledge of rational medication use,belief,and medication adherence scoreswere higher than those of the control group in the intervention group.Knowledge of rational medication,belief,and medication adherence scorewere higher than those in the control group,and the difference was statistically significant(P<0.05).After the intervention,the proportion of patients in the intervention group who established the habit of reminding medication,placed medication in a conspicuous location,and involved family members to assist with medication reminders,used split pill boxes,and recorded medication notes were higher than those in the control group.The difference was statistically significant(P<0.05).Conclusion The rational medication management model for the elderly in the community can help strengthen the family doctor team services,enhance the patients' knowledge and belief in rational medication use,and improve the patients' adherence and standardization of medication use behavior.