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高血壓患者服藥遵從行為及其相關因素之探討

An Exploration of the Drug Compliant Behaviors and Associated Factors of Hypertensive Patients

摘要


本研究目的為探討國人罹患高血壓之服藥遵從行為、遵從率及其相關因素。採二階段分層不等比率系統隨機抽樣,自台灣地區17個醫療區域中,抽取桃園及台中醫療網之醫院、衛生所建檔之600位原發性高血壓患者,進行居家訪視會談及自陳式結構性問卷調查,所得資料以SAS為主進行統計分析,研究結果如下: 高血壓患者最常發生的不遵從服藥行為是更改服藥時間、停止或斷續服藥及減少服藥次數。服藥連從行為量表平約得分小於等於3.78分,即每星期有2天以上未服藥者,其收縮壓或舒張壓值會高於正常範圍(W.H.O.定義),據此標準,求得國人罹息高血壓之服藥不遵從率為22.03%,遵從率為42.6%。 因徑分析結果發現,權威型外控人格特質、抗高血壓藥物的認知、所有藥物種類(三、四種或五種以上)及服用抗高血壓藥物顆數(三、四顆),均對病人的服藥遵從行為有正向且直接之影響;抗高血壓藥物壞處的感受及服用抗高血壓藥物的次數,對病人服藥連從行為有直接且負向之影響,解釋力(R^2)為18.23%。而教育程度、年齡、主要使用語言、抗高血壓藥物知識、醫病關係及親友支持,則需透過健康信念對服藥連從行為產生間接之影響。 故醫護人員可從病人的年齡、教育程度、主要使用語言、服藥種類、次數、顆數及人格特質,預測病人是否為高危險人口群,易有不連從服藥之傾向,主動與病人建立良好之醫病關係,並加強其對抗高血壓藥物的認知,鼓勵親友關懷病人並提醒服藥,澄清且讓病人抒發對服藥壞處的感受,以促進病人的服藥連從行為。

並列摘要


The purposes of this study were to investigate drug compliant behaviors, compliant rate and associated factors of hypertensive patients in Taiwan. The method of sampling was two phases of stratified, systemic random sampling. The sampling was composed of 600 hypertensive patients from hospitals and public health clinic in who had been treated over three months in Taoyuan and Taichung medical networks. Data was collected by interviewing and questionnaire and SAS computer programs. Structural equation model was selected as the multivariate analysis method to examine compliant behavior. Path multivareate analysis method to examine compliant behavior. Path analysis was used to test the hypothesized conceptural framework. The major findings of the study were: (1) An objective definition of drug noncom- pliant behavior is the score of compliant behavior scale less than 3.78, and systolic blood pressure more than l60mmHg or diastolic blood presure more than 95mmHg. The rate of drug noncompliant is 22.03%. (2) The six signigicant and directed variable in the model explained 18.23% of the variance in drug compliant behavior. Those variables were powerful-other-wxternal health locus of control knowledge of antihypertensive drug、 kinds of pill、 times of pill、 pill counts and perception of antihypertensive drug's disadvantage. (3) The patients' age、 education、 language、 doctor-patient relationship and family support affected drug compliant behavior indirectly, may be mefiated through health belief.

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