CAJ | 학술논문

目的研究社区高血压患者药物治疗依从性与自评获得卫生服务质量的相关性.方法采用多阶段整群随机抽样的方法,于2013年5月在上海市某城区管辖的36个街道中分别抽取2个居委会,共72个居委会,从每个居委会所在街道的社区卫生服务中心目前建档的高血压患者库中各抽取25例患者,共计发放问卷1 800份,将其中1 172例服药者作为研究对象.采用《Morisky服药依从性量表》评价研究对象的服药依从性;采用《患者自评慢性病卫生服务质量量表》测量患者自评获得卫生服务质量.采用Spearman秩相关分析自评获得卫生服务质量与高血压患者药物治疗依从性的关系;采用二分类logistic回归分析高血压患者服药依从性影响因素.结果在1 172例研究对象中,社区高血压患者服药依从性佳者567例(48.4％),其中,年龄≤65岁患者占43.3％(245例),＞65岁患者占56.7％(321例);自评获得卫生服务质量总体及各维度评分与满分(5分)存在较大差距,其中自评获得卫生服务质量总体评分为(2.67±1.33)分,各维度中患者主动性维度得分最高,也仅为(2.56±1.41)分,随访和协作维度得分最低,只有(1.97±1.49)分,Spearman秩相关分析结果显示,患者主动性与高血压患者药物治疗依从性呈负相关(rs=-0.09,P＜0.01);二分类logistic回归分析显示,年龄＞65岁高血压患者药物治疗依从性佳的可能性是≤65岁患者的1.49倍(95％CI:1.11～2.00),患者主动性评分高是高血压患者药物治疗依从性佳的保护因素,OR(95％ CI)值为1.35(1.14 ～1.59).结论目前社区高血压患者药物治疗依从性总体不高,其自评获得卫生服务质量水平较低;医务人员在疾病的管理过程中积极发挥患者主动性能有效提高其药物治疗依从性.
목적 연구사구고혈압환자약물치료의종성여자평획득위생복무질량적상관성.방법 채용다계단정군수궤추양적방법,우2013년5월재상해시모성구관할적36개가도중분별추취2개거위회,공72개거위회,종매개거위회소재가도적사구위생복무중심목전건당적고혈압환자고중각추취25례환자,공계발방문권1 800빈,장기중1 172례복약자작위연구대상.채용《Morisky복약의종성량표》평개연구대상적복약의종성;채용《환자자평만성병위생복무질량량표》측량환자자평획득위생복무질량.채용Spearman질상관분석자평획득위생복무질량여고혈압환자약물치료의종성적관계;채용이분류logistic회귀분석고혈압환자복약의종성영향인소.결과 재1 172례연구대상중,사구고혈압환자복약의종성가자567례(48.4％),기중,년령≤65세환자점43.3％(245례),＞65세환자점56.7％(321례);자평획득위생복무질량총체급각유도평분여만분(5분)존재교대차거,기중자평획득위생복무질량총체평분위(2.67±1.33)분,각유도중환자주동성유도득분최고,야부위(2.56±1.41)분,수방화협작유도득분최저,지유(1.97±1.49)분,Spearman질상관분석결과현시,환자주동성여고혈압환자약물치료의종성정부상관(rs=-0.09,P＜0.01);이분류logistic회귀분석현시,년령＞65세고혈압환자약물치료의종성가적가능성시≤65세환자적1.49배(95％CI:1.11～2.00),환자주동성평분고시고혈압환자약물치료의종성가적보호인소,OR(95％ CI)치위1.35(1.14 ～1.59).결론 목전사구고혈압환자약물치료의종성총체불고,기자평획득위생복무질량수평교저;의무인원재질병적관리과정중적겁발휘환자주동성능유효제고기약물치료의종성.
Objective To study the relationship between compliance with anti-hypertension therapy and assessment of quality of health care in hypertensive patients in community.Methods According to multi-stage cluster random sampling,we selected two communities from 36 streets in certain areas of Shanghai respectively using random number method on May,2013,72 communities in total,then we randomly selected 25 patients who were archived in the community health center from each community of the street.We conducted 1 800 questionnaires in total in which 1 172 patients were under medication study.The Morisky Medication Adherence Scale was used to evaluate medication compliance while the Patient Assessment of Chronic Illness Care Scale was applied to measuring the quality of patient's self-reported health service.The Spearman rank correlation analysis was used to evaluate the relationship between assessment of quality of health care for chronic illness and compliance with anti-hypertension therapy.Binary logistic analysis was applied to evaluate the factors which influenced patient's medicine compliance.Results There were 567 (48.4％) respondents with good compliance.Age less than or equal to 65 accounted for 43.3％ (245 people) while age greater than 65 accounted for 56.7％ (321 people).The average scores of total and difference dimensions remained at a low level,ranging from 1.97 to 2.67 out of 5.The Assessment of quality of health care score was (2.67 ± 1.33) scores,in which the highest score of the dimensions was patient activation which was (2.56 ± 1.41)scores and the lowest was follow-up / collaboration which was (1.97 ± 1.49) scores.The Spearman rank correlation analysis showed that negative association between accumulate points of patient medicine compliance and patient activation was found (rs =-0.09,P ＜ 0.01).The result of binary logistic analysis indicated that medication adherence of age greater than 65 was 1.49 times (95％ CI:1.11-2.00) higher than age less than or equal to 65.The patient activation was a protective factors of good medicine adherence (OR =1.35,95％ CI:1.14-1.59).Conclusions The medicine adherence of hypertension patients in community medication compliance is not very good at the moment.The self-rated quality of health care is still relative poor.Positive activation from interaction of physicians and patients can help enhancing patient's medicine compliance.