重度β型海洋性貧血患者對排鐵藥物Deferasirox的認知與服藥行為之研究

A Study of Knowledge about Deferasirox and Behavior of Taking Deferasirox in Patients with β-Thalassemia Major

梅珮儀(Pei-Yi Mei)

指導教授 ： 李雅玲

國立臺灣大學/醫學院/護理學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.00887

摘要

研究背景：重度海洋性貧血症患者因造血功能異常需要定期輸血治療。輸血所衍生之副作用以鐵質沉積症所引發的器官衰竭，最易引發死亡。Deferasirox (Exjade)於2005年在美國、歐洲經過認可上市，臺灣於2007年通過健保給付用藥，每天口服一次的鐵螯合劑，是否可以提升患者的服藥行為，為本研究欲探討之主要目的。
研究目的：目的有三：一、了解患者對Deferasirox之藥物認知程度及服藥行為之現況。二、分析患者基本屬性與藥物認知程度、服藥行為之差異。及三、分析患者藥物認知程度與服藥行為之相關。
研究方法：本研究為相關性及橫斷式研究，採立意取樣，使用自擬的量表調查重度β型海洋性貧血患者對口服排鐵劑Deferasirox之藥物認知程度及服藥行為及其相關性。收案地點為臺大醫院海洋性貧血專科門診，針對符合收案標準且同意參與研究的患者進行收案，實際收案人數為42人。
研究工具：本研究以自擬之藥物認知問卷，依據藥物作用、副作用、服藥方法、注意事項共10題；服藥行為量表共12題作為施測工具。
研究結果：患者在藥物知識得分上，總分為10分，得分範圍介於5-10分，平均分數8.43±1.34分；服藥相關行為總分60分，得分範圍介於35-57分，平均分數45.29±4.47分，結果顯示患者的藥物知識程度與服藥行為皆有待加強。患者的基本屬性與藥物認知程度之差異檢定，僅患者有鐵質沉積併發症與藥物認知程度之檢定結果呈現顯著差異(t=-2.37，P=0.02*)，即有鐵質沉積併發症之患者其藥物認知程度顯著較佳。而患者的基本屬性與服藥相關行為之差異檢定結果顯示，不同的年齡分組與服藥相關行為有顯著差異（F=3.89，P=0.01*），然而以Scheffé事後檢定比較結果顯示各組之間與服藥行為無顯著差異；此外，最近一次血清鐵濃度與服藥相關行為有顯著差異（F=3.73，P=0.01*），以Scheffé事後檢定進行比較結果顯示最近一次血清鐵濃度值小於等於2000 mg/dl、介於2001 mg/dl與4000 mg/dl之間、與大於等於4001 mg/dl三組之間在服藥行為上無顯著差異。本研究藥物認知問卷Cronbach’s α係數為0.44，服藥相關行為問卷Cronbach’s α係數為0.29，兩份問卷皆顯示信度偏低，因此無法進行相關性分析。
討論：從本研究發現，顯示患者普遍知識程度未達理想，服藥行為尚有待加強。可能與患者主述的「看不到立即的回饋」而減低服藥之動機有關，此因素須再進一步研究探討。
結論：本研究使用問卷調查所得資料，可協助臨床護理人員知道患者所缺乏的面向，給予增強及提出有效策略處理。

關鍵字

重度β型海洋性貧血症 ； 口服排鐵劑 ； 藥物認知 ； 服藥行為

並列摘要

Background: Patients with β-thalassemia major require life-long periodic blood transfusions for treatment due to abnormal hematopoietic function. Among all the side effects derived from blood transfusion, organ failure caused by hemochromatosis is the most common cause leading to death. Deferasirox (Exjade) was approved for marketing in the Unites States and Europe in 2005. In 2007, it was approved in Taiwan to be covered by National Health Insurance. This study intended to investigate whether the administration of once-daily oral iron chelator can improve patients’ drug-taking behavior.
Purposes: There are three detailed purpose. 1. To understand patients’ knowledge of drug and the current status of their drug-taking behavior; 2. to analyze the differences in patients’ basic information, knowledge of drug, and drug-taking behavior; and 3. to analyze the correlation between patients’ knowledge of drug and drug-taking behavior.
Methods: This is a correlation and cross-sectional research. By purposive sampling, this study administered self-developed scales to investigate the knowledge of drug and drug-taking behavior of oral iron chelator, Deferasirox, and their correlation in patients with β-thalassemia major. The research site was the special outpatient clinic for β-thalassemia major at the National Taiwan University Hospital. This study enrolled the patients meeting the inclusion criteria and agreeing to participate in this study as the subjects. 42 patients were actually enrolled.
Tools: A self-developed questionnaire of the knowledge of drug was used to conduct a questionnaire survey. The questionnaire included a total of 10 items, such as mechanism of drug, side effects, medication method, and notices. Moreover, a 12-item drug-taking behavior scale was also used as the research tool.
Results: In terms of patients’ score of knowledge of drug, the score ranged from 5 to 10 points. The total score was 10 points, and the average score was 8.43±1.34 points. The total score of drug-taking behavior was 60 points. The score ranged from 35 to 57 points, and the average score was 45.29±4.47 points. The results showed that both patients’ knowledge of drug and drug-taking behavior should be improved. The test on the difference between patients’ basic properties and knowledge of drug showed that a significant difference was only found in the result of knowledge of drug in patients complicated by hemochromatosis (t=-2.37, P=0.02*). In other words, patients complicated by hemochromatosis had better knowledge of drug. The result of the test on the difference between patients’ basic properties and drug-taking behavior showed that age had a significant effect (F=3.89, P=0.01*) on patients’ drug-taking behavior. However, the result of Scheffé’s post hoc comparison showed that there was no significant difference in drug-taking behavior among various groups. Besides, the latest serum iron centration had a significant effect on drug-taking behavior (F=3.73, P=0.01*). The result of Scheffé’s post hoc comparison showed that the latest serum iron concentration (the patients whose serum iron concentration ≦ 2000 mg/dl, and those whose serum iron concentration between 2001 mg/dl and 4000 mg/dl, and those whose serum iron concentration ≧ 4001 mg/dl) three groups did not have a significant difference on drug-taking behavior. The Cronbach’s α coefficient of the questionnaire on knowledge of drug was 0.44, and that of the questionnaire on drug-taking behavior was 0.29. The reliability of the two questionnaires was lower than the acceptable level. Therefore, it was impossible to perform correlation analysis.
Discussions: Discussions: Based on the findings of current study, indicating the patient's general knowledge level is below the satisfactory level, the patient's drug-taking behavior still needs improvement in this study. The main factor is “unable to see immediate feedback”, which probably reduces the attitude to take medication. It need to research further.
Conclusions: The results of the study could be used to assist clinical nursing personnel in finding out the deficiencies of patients, improve their deficiencies, and propose effective strategies to handle them.

並列關鍵字

β-thalassemia major ； oral form of iron chelator ； knowledge of drug ； drug-taking behavior

參考文獻

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