中国全科医学 ›› 2022, Vol. 25 ›› Issue (31): 3904-3913.DOI: 10.12114/j.issn.1007-9572.2022.0340

所属专题: 共病最新文章合集

• 论著·人群健康研究 • 上一篇    下一篇

慢性病共病患者服药依从性潜在类别及其影响因素分析

张振香1,*(), 何福培1, 张春慧1, 林蓓蕾1, 平智广2, 郭惠娟3   

  1. 1.450001 河南省郑州市,郑州大学护理与健康学院
    2.450001 河南省郑州市,郑州大学公共卫生学院
    3.471009 河南省洛阳市,郑州大学附属洛阳中心医院护理部
  • 收稿日期:2022-04-25 修回日期:2022-09-05 出版日期:2022-11-05 发布日期:2022-09-19
  • 通讯作者: 张振香
  • 张振香,何福培,张春慧,等.慢性病共病患者服药依从性潜在类别及其影响因素分析[J].中国全科医学,2022,25(31):3904-3913.[www.chinagp.net]
    作者贡献:张振香负责研究的设计、实施、文章质量控制及审校,并对文章整体负责、监督管理;何福培负责数据的整理、结果的分析与解释、论文撰写与修订;平智广负责统计学处理;张春慧、林蓓蕾负责论文的修订;郭惠娟负责数据的收集。
  • 基金资助:
    河南省科技攻关项目——基于mHealth的社区多重慢病用药安全管理:以家庭为中心的随机对照研究(182102310198)

Latent Class Analysis and Influencing Factors of Medication Adherence in Multiple Chronic Conditions Patients

ZHANG Zhenxiang1,*(), HE Fupei1, ZHANG Chunhui1, LIN Beilei1, PING Zhiguang2, GUO Huijuan3   

  1. 1.School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China
    2.College of Public Health, Zhengzhou University, Zhengzhou 450001, China
    3.Nursing Department, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang 471009, China
  • Received:2022-04-25 Revised:2022-09-05 Published:2022-11-05 Online:2022-09-19
  • Contact: ZHANG Zhenxiang
  • About author:
    ZHANG Z X, HE F P, ZHANG C H, et al. Latent class analysis and influencing factors of medication adherence in multiple chronic conditions patients [J] . Chinese General Practice, 2022, 25 (31) : 3904-3913.

摘要: 背景 慢性病共病患者比例逐年上升,遵医嘱服药被认为是慢性病管理的有效措施。目前,慢性病共病患者的服药依从性仍有待提高,明确慢性病共病患者服药不依从的原因及影响因素对于慢性病的防控至关重要。 目的 对慢性病共病患者服药依从性进行分类,分析慢性病共病患者服药依从性类别的影响因素。 方法 于2021年7—9月,采用便利抽样法,在河南省2家综合性三级甲等医院选取住院患者267例,采用中文版服药信念特异性问卷(BMQ-Specific)、中文版8条目Morisky服药依从性量表(MMAS-8)、用药知识问卷等对患者进行调查,应用潜在类别分析对慢性病共病患者服药依从性进行分类。比较不同服药依从性类别慢性病共病患者在人口学特征、用药情况、用药知识和服药信念等方面的差异,采用多元Logistic回归分析慢性病共病患者服药依从性类别的影响因素。 结果 潜在类别分析结果显示,慢性病共病患者服药依从性可分为3个潜在类别:主观服药依从性不佳组(潜在类别概率为18.0%)、整体服药依从性较差组(潜在类别概率为34.4%)和整体服药依从性较优组(潜在类别概率为47.6%);不同服药依从性类别群体受教育程度、患病后工作情况、居住情况、家庭人均月收入、收入来源、获药师指导者占比、服药种数、服药频率、服药年限、中文版BMQ-Specific得分、用药知识问卷得分比较,差异有统计学意义(P<0.05)。多元Logistic回归结果显示:相对于主观服药依从性不佳组,获药师指导者、中文版BMQ-Specific得分较高者、用药知识问卷得分较高者更易入整体服药依从性较优组,因病退休、收入来源为子女赡养费者更不易入整体服药依从性较优组(P<0.05);相对于整体服药依从性较差组,已退休者、服药频率为1次/d者、获药师指导者、中文版BMQ-Specific得分较高者、用药知识问卷得分较高者更易入整体服药依从性较优组(P<0.05)。 结论 慢性病共病患者服药依从性存在3个潜在类别,因病退休、收入来源为子女赡养费者更有可能出现服药依从性不佳的情况,应多关注其服药依从性情况;低服药频率、获药师指导,以及服药知识、信念水平高可预测慢性病共病患者整体服药依从性较优。

关键词: 慢性病共病, 服药依从性, 潜在类别分析, 影响因素分析

Abstract:

Background

The cases of multiple chronic conditions are increasing yearly, yet their medication adherence is unsatisfactory though taking medication as prescribed is recognized as the most effective measure to manage chronic diseases. To improve the prevention and control of chronic diseases, it is crucial to identify the causes and influencing factors of non-compliance in multiple chronic conditions patients.

Objective

To classify the medication adherence and to identify the associated factors of each class of medication adherence in multiple chronic conditions patients.

Methods

This investigation was conducted between July and September 2021 with a convenience sample of 267 inpatients from two tertiary A general hospitals of Henan Province using the Chinese version of Beliefs about Medicines (BMQ-C) , the Chinese version of 8-item Morisky Medication Adherence Scale (MMAS-8-C) , and the Medication Knowledge Scale (MKS) . Latent class analysis was used to classify the medication adherence. Demographic characteristics, medication use, medication knowledge and medication beliefs were compared by the class of medication adherence. Multiple Logistic regression was used to explore the associated factors of each class of medication adherence.

Results

The medication adherence of the participants was divided into three latent classes, namely subjective poor medication adherence, overall poor medication adherence, and overall good medication adherence, and the prevalence of the three classes was 18.0%, 34.4% and 47.6%, respectively. The education level, occupational status after an illness, living situation, household monthly income per person, financial resources, prevalence of having pharmacist guidance, number of medications, frequency of taking medication, years of taking medication, the BMQ-C score, and MKS score in the participants differed significantly by the class of medication adherence (P<0.05) . By multiple Logistic regression analysis, compared with patients with subjective poor medication adherence, those with overall good medication adherence had higher prevalence of having pharmacist guidance, and higher average scores of BMQ-C and MKS, and lower prevalence of retirement due to illness and offspring's support as the only financial resource (P<0.05) . Compared with those with overall poor medication adherence, those with overall good medication adherence had higher prevalence of retirees, taking medication once a day, and having pharmacist guidance, as well as higher average scores of BMQ-C and MKS (P<0.05) .

Conclusion

The medication adherence in these multiple chronic conditions patients could be classified into three latent classes. More attention should be given to those who were retired due to illness or financially supported by their children, because they were prone to having poor medication adherence. Those who had lower frequency of medication use, medication guidance from a pharmacist, and higher levels of medication knowledge and beliefs were prone to having good medication adherence.

Key words: Multiple chronic conditions, Medication adherence, Latent class analysis, Root cause analysis