缺血性卒中患者服药依从性影响因素分析

Analysis of the Influencing Factors of Medication Adherence in Ischemic Stroke Patients

目的调查缺血性卒中患者服药依从性的影响因素。方法前瞻性连续纳入首都医科大学附属北京天坛医院国际部2022年6月—2023年12月的缺血性卒中住院患者。采用问卷调查收集患者的一般情况、服药依从性[采用Morisky服药依从性量表(Morisky medication adherence scale,MMAS)评估]、感知健康能力[采用中文版感知健康能力量表(perceived health competence scale,PHCS)评估]、卒中复发情况等信息。根据MMAS评分将患者分为依从性差(MMAS评分<6分)组和中高依从性(MMAS评分≥6分)组。比较两组的人口学特点、临床特点和血管危险因素情况,并采用多因素logistic回归分析服药依从性的影响因素。结果共纳入缺血性卒中患者212例,平均年龄(59.9±5.9)岁,MMAS评分6(6~7)分,其中服药依从性差组41例(19.34%),中高依从性组171例(80.66%)。多因素logistic回归分析显示,初中及以下学历患者依从性差的风险是大专及以上学历患者的6.290倍(95%CI 1.912~20.689,P=0.002);无配偶患者依从性差的风险是有配偶患者的4.172倍(95%CI 1.372~12.684,P=0.012);无业患者依从性差的风险是在职患者的4.115倍(95%CI 1.326~12.773,P=0.014);PHCS评分低水平的患者服药依从性差的风险是中等水平患者的2.190倍(95%CI 1.098~4.370,P=0.026)。中高依从性组患者出院后1个月(99.42%vs.92.68%,P=0.004)、3个月(98.83%vs.80.49%,P<0.001)和6个月(98.25%vs.75.61%,P<0.001)的随访完成率均高于依从性差组;3个月(3.55%vs.12.12%,P=0.038)、6个月(4.76%vs.16.13%,P=0.019)的卒中复发率低于依从性差组。结论初中及以下学历、无配偶、无业、PHCS评分低的缺血性卒中患者服药依从性差的风险较高。护理人员应综合考虑患者的个体差异,制订并实施个体化的健康教育计划,以提高患者的服药依从性。

Objective To investigate the influencing factors of medication adherence in ischemic stroke patients.Methods This prospective study consecutively included the ischemic stroke inpatients at the international department of Beijing Tiantan Hospital,Capital Medical University from June 2022 to December 2023.A questionnaire was used to collect information on patients’general information,medication adherence[evaluated by the Morisky medication adherence scale(MMAS)],perceived health competence[assessed by the perceived health competence scale(PHCS)],and stroke recurrence.The patients were divided into a poor adherence group(MMAS score<6)and a medium-high adherence group(MMAS score≥6)based on their MMAS scores.The demographic characteristics,clinical features,and vascular risk factors of the two groups were compared,and the influencing factors of medication adherence were analyzed using multivariate logistic regression analysis.Results A total of 212 patients with ischemic stroke were included in this study,with a mean age of(59.9±5.9)years,and an MMAS score of 6(6-7),of whom 41 cases(19.34%)belonged to the poor adherence group and 171 cases(80.66%)belonged to the medium-high adherence group.The multivariate logistic regression analysis showed that the risk of poor compliance in patients with a junior high school education or below was 6.290 times higher than that of patients with a college degree or above(95%CI 1.912-20.689,P=0.002);the risk of poor adherence in patients without a spouse was 4.172 times higher than that of patients with a spouse(95%CI 1.372-12.684,P=0.012);the risk of poor compliance in unemployed patients was 4.115 times higher than that of employed patients(95%CI 1.326-12.773,P=0.014);and the risk of poor compliance in patients with low PHCS scores was 2.190 times higher than that of patients with moderate PHCS scores(95%CI 1.098-4.370,P=0.026).Patients in the medium-high adherence group had higher follow-up completion rates at 1-month(99.42%vs.92.68%,P=0.004),3-month(98.83%vs.80.49%,P<0.001)and 6-month(98.25%vs.75.61%,P<0.001)after discharge than those in the low medication adherence group,and the difference was statistically significant.Meanwhile,the stroke recurrence rates of patients at 3-month(3.55%vs.12.12%,P=0.038)and 6-month(4.76%vs.16.13%,P=0.019)follow-up visits were lower than those of patients with low adherence,and the differences were statistically significant.Conclusions Patients with a junior high school education or below,without a spouse,unemployed,and with a low PHCS score are at a higher risk of poor medication adherence.Nursing staff should consider the individual differences of patients comprehensively,and develop and implement personalized health education plans to improve patients’medication adherence.