冠狀動脈疾病病人藥物治療信守之相關因素探討

Correlates of medication adherence in patients with coronary artery disease

黃任瑩(Jen-Ying, Hung)

指導教授 ： 許敏桃

共同指導教授 ： 陳幸眉(Hsing-Mei Chen)

高雄醫學大學/護理學院/護理學系研究所/碩士(2014年)

摘要

本研究之研究目的在於探討冠狀動脈疾病病人藥物治療信守現況，分析冠狀動脈疾病病人藥物治療信守與人口學基本屬性、疾病變項及藥物治療變項之差異及相關性，並找出影響藥物治療信守的重要預測因子。採橫斷式、描述性及相關性研究設計，以非隨機取樣方式，於南部某醫學中心之心血管內科門診及病房進行收案，共招募到250位冠狀動脈疾病病人完成一份結構式問卷。收案條件包括(1)年滿20歲、(2)經心臟科醫生診斷為冠狀動脈疾病者（ICD-9-CM Diagnosis Code 410-414）、(3)已接受冠狀動脈疾病藥物治療至少三個月、(4)能以國、台語溝通者、和(5)同意參與本研究者。所收集的資料採用SPSS 20.0 version for Windows及SAS 9.3版之統計軟體進行統計分析，以tobit迴歸分析法找出藥物治療信守的重要預測因子。
研究結果顯示，冠心病個案於藥物治療信守知識構面得分由0分至3分，平均得分為1.92分；態度構面之得分由11分至30分，平均得分為26.71分；最後，障礙構面得分由0分至68分，平均得分為5.90分。Tobit迴歸分析發現，知識構面重要預測因子為「態度構面」、「服藥副作用」及「用藥指導」；態度構面重要預測因子為「知識構面」、「障礙構面」、「年齡」、「教育程度-高中職」及「心導管次數」；障礙構面重要預測因子為「態度構面」、「年齡」、「目前有職業」、「未定期返診」及「心臟症狀」。
本研究結果顯示多數病人有高藥物治療信守，而年紀較輕、教育程度不識字及專科以上畢業者、有職業、未規則返診、首次行心導管檢查、心臟症狀多及未接受過用藥指導者為低藥物治療信守之高危險群病人。此外，僅有21.2%的個案表示接受到完整的用藥指導，如何落實完整用藥指導極待改善。

關鍵字

冠心病 ； 藥物治療信守知識 ； 藥物治療信守態度 ； 藥物治療信守障礙

並列摘要

The purposes of this study were to explore the status quo of medication adherence; to analyze the correlations of medication adherence with demographic characteristics, disease variables, and medication variables; and to identify significant predictors of medication adherence in patients with coronary artery disease (CAD). A cross-sectional, descriptive correlational design was used. A non-probability sample of 250 participants was recruited from the cardiology outpatient department and ward of a medical center located in southern Taiwan and then was asked to complete a structured questionnaire. Inclusion criteria were as follows: (1) being 20 years or older, (2) having a diagnosis of CAD (ICD-9-CM Diagnosis Code 410-414) as determined by cardiologists, (3) having received CAD medications for at least three months, (4) being able to communicate either by Mandarin or Taiwanese, and (5) willing to participate in this study. Data were analyzed using SPSS version 20.0 for Windows and SAS version 9.3. A tobit regression was conducted to identify significant predictors of medication adherence.
The results showed that in the participants with CAD, the mean knowledge dimension score of medication adherence was 1.92 (range, 0-3); the mean attitude dimension score was 26.71 (range, 11-30); the mean barrier dimension score was 5.90 (range, 0-68). The results of tobit regression analysis showed that “attitude dimension,” “medication side effects,” and “medication counseling” were significant predictors of knowledge dimension; “knowledge dimension,” “barriers dimension,” “age,” “education-high school,” and “frequency of cardiac catheterization” were significant predictors of attitude dimension; “attitude dimension,” “age,” “current employment,” “irregular follow-up,” and “cardiac symptoms” were significant predictors of barriers dimension.
The findings of this study indicated that most of the participants had high medication adherence; however, those with younger age, being illiterate and at a college education level or above, employed, with irregular follow-up, on the first cardiac catheterization, with more cardiac symptoms, and without receiving any medication counseling were patients at high risk for low medication adherence. Moreover, only 21.2% of the participants reported receiving comprehensive medication counseling. Further improvement is therefore urgently needed to better implement comprehensive medication counseling services.

並列關鍵字

coronary artery disease (CAD) ； knowledge of medication adherence ； attitude toward medication adherence ； barriers to medication adherence

參考文獻

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