末期腎臟病前期病人其健康知能、醫病關係、服藥遵從之相關性研究

The Study on the Relationship between Health Literacy, Physician Patient Relationship and Medication Adherence among Patients with Pre-ESRD of CKD.

蔡宜珊(Yi-Shan Tsai)

指導教授 ： 張肇松

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2014年)

摘要

背景與目的 慢性病逐漸取代急性病，成為死亡人口主因，其中慢性腎臟病人數多寡顯著影響國家的醫療費用，但在慢性腎臟病患者中，健康知能缺乏是ㄧ個常見的問題。醫病互信是慢性病照護的基礎，且與服藥遵從有關，因此本研究旨在探討末期腎臟病前期患者健康知能、醫病關係對服藥遵從之相關性。
方法 本研究採橫斷式問卷調查法，對高雄市區域醫院、地區醫院、一般診所與腎臟內科診所中末期腎臟病前期患者，年齡在20歲以上75歲以下，且就醫期間達三個月以上者進行ㄧ對ㄧ訪談，共計蒐集104份問卷。問卷使用Wright et al.(2011)的慢性腎臟病知能量表、Hall et al.(2002)的醫病信任量表與Morisky et al.,(2008)的服藥遵從量表。統計分析以SPSS 19.0統計軟體進行變數間的差異與相關分析，並以迴歸分析探討健康知能、醫病關係對於服藥遵從之影響。
結果 研究結果發現：患者平均年齡為64.73歲，58.7%為男性。末期腎臟病前期患者其健康知能分數(三構面)未達60分，且健康知能與服藥遵從無相關，但服藥信念卻會影響患者的遵從行為；醫病關係與服藥遵從行為有顯著相關。
結論 健康知能與服藥遵從無相關，而醫病關係是提升患者服藥遵從的潛在因子，此外，對服藥有正向信念的患者其遵從行為也較佳。未來增加收案數後，將再進行服藥遵從行為與各臨床指標結果分析。

關鍵字

末期腎臟病前期 ； 健康知能 ； 醫病關係 ； 服藥遵從

並列摘要

Background Limited Heatlh Literacy is common problem among people with chronic kidney disease. Patient Trust is a foundation of chronic care are associated with better medication adherence.
Objective The relationship between Health Literacy, Physician Patient Relations, and self-reported Medication Adherence are examined.
Methods This study is a cross-sectional study using a well-designed, structured questionnaire containing the instruments of Kidney Disease Knowledge Survey (KiKS), Wake Forest Trust Scale (WFT), and Morisky Medication Adherence Scale (MMAS-8) to survey the relationship between health literacy, physician-patient relationship and medication adherence in pre-ESRD patients. A total of 104 adults pre-ESRD patients from outpatient service of 4 different clinics were enrolled for study. Data were recorded for statistical analysis using SPSS 19.0 software.
Results Mean patient age was 64.73 years, 58.7% were male.The pre-ESRD patients’ health literacy score under <60. Health literacy was not associated with medication adherence. Positive Health beliefs and Physician Patient Relations were associated with better medication adherence.
Conclusion These findings indicate that Physician–patient relations and health-related beliefs of patients contribute to patient adherence.

並列關鍵字

Pre-ESRD ； Health Literacy ； Physician Patient Relationship

參考文獻

Wen, C. P., Cheng, T. Y., Tsai, M. K., Chang, Y. C., Chan, H. T., Tsai, S. P., . . . Wen, S. F. (2008). All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet, 371(9631), 2173-2182. doi: 10.1016/s0140-6736(08)60952-6

英文文獻

Baker, D. W., Parker Rm Fau - Williams, M. V., Williams Mv Fau - Clark, W. S., & Clark, W. S. (1998). Health literacy and the risk of hospital admission. (0884-8734 (Print)). doi: D - NLM: PMC1497036 EDAT- 1998/12/09 MHDA- 1998/12/09 00:01 CRDT- 1998/12/09 00:00 PST - ppublish

Baker, D. W., Williams, M. V., Parker, R. M., Gazmararian, J. A., & Nurss, J. (1999). Development of a brief test to measure functional health literacy. Patient Educ Couns, 38(1), 33-42.

Bello, A. K., Nwankwo, E., & El Nahas, A. M. (2005). Prevention of chronic kidney disease: a global challenge. Kidney Int Suppl(98), S11-17. doi: 10.1111/j.1523-1755.2005.09802.x