某醫學中心中風高血壓病人遵醫囑服藥行為階段及相關因素之探討

An Exploration of the Stage of Drug Compliant Behaviors and Related Factors of Stroke and Hypertensive Patients at a Medical Center

彭莉琴(Li-Chin Peng)

指導教授 ： 鄭惠美

國立臺灣師範大學/教育學院/衛生教育學系/碩士(2000年)

摘要

腦中風高居我國十大死因第三位，根據臨床經驗發現腦中風病人復發而再度入院的原因多為不遵醫囑服藥，因而，本研究依據PRECEDE模式為理論架構，以瞭解中風高血壓病人遵醫囑服藥行為階段的情形，並探討素質、使能、輔強等三類因素與遵醫囑服藥行為階段的關係。
本研究以某醫學中心神經及腦血管障礙門診，診斷為腦中風與高血壓者為研究對象，抽取301人進行問卷調查，所得資料以描述性統計、卡方檢定等統計方法進行分析，重要結果如下：
一、研究對象的服藥行為遵從程度偏高。遵醫囑服藥行為階段的情形，處於「沈思前期」佔2.7﹪，「沉思期」佔1.7﹪，「準備期」佔15.9﹪，「行動期」佔5.3﹪，其中中風治療期間為6個月及以下者佔93.8﹪，「維持期」佔74.4﹪。
二、不遵醫囑服藥的原因：（1）隨心情、身體狀況調整服藥；（2）忘記服藥；（3）自行更改服藥方式後，無不適；（4）藥物太複雜；（5）害怕與其他藥相互作用；（6）不知藥已更改；（7）擔心副作用或有副作用；（8）試看看不吃藥會如何。
三、在素質因素中，中風治療期間為1年及以下處於「行動期」者明顯多於治療1.1年及以上者。
四、在使能因素中，無疲倦的副作用者，其遵醫囑服藥行為階段較多處於「維持期」。
五、在輔強因素中，社會支持高者遵醫囑服藥行為較社會支持低者好，多處於「行動期」、「維持期」。
依據研究結果提出對未來研究、臨床醫療照護及行政上的建議，作為日後研究、醫療服務人員、行政措施之參考。

關鍵字

中風 ； 高血壓 ； 遵醫囑服藥行為 ； 健康信念 ； 社會支持 ； 改變階段模式

並列摘要

ABSTRACT
Stroke is the third leading cause of death in our country . According to the clinical experience , we found most stroke patients hospitalized again because of drug noncompliance . Therefore , this study was based on PRECEDE model as the theoretical structure in order to comprehend the stage of drug compliant behaviors of stroke and hypertensive patients and explored the relationship between the factors in predisposing , enabling , and reinforcing and the stage of drug compliant behaviors .
We enrolled three hundred and one patients diagnosed as stroke and hypertension in the outpatient department at a medical center to embark on questionnaires . The acquired data was analyzed by descriptive statistics and Chi-square test .
The main results of this study were as follows：
1.Subjects had a high score on drug compliant behaviors scale . The percentages of each stage for drug compliant behaviors were as follows：precontemplation 2.7 , contemplation 1.7 , preparation 15.9 , action 5.3 , and maintenance 74.4 .
2.The reasons for drug noncompliance included：（1）adjusted to take the medicine according to mood and health status ,（2）forgot to take the medicine ,（3）felt fine after changing the way of taking medicine by themselves ,（4）complicated medication ,（5）feared for the interaction with the other medicine ,（6）didn’t know the medicine had been changed ,（7）worried about side effects or having side effects ,（8）tried to find what would happen without taking any medicine .
3.In predisposing factors , the drug compliant behaviors in action stage , subjects who had accepted stroke treatment for one year（and less）were more than for 1.1 years（and above）.
4.In enabling factors , for most subjects who had no fatigue caused by drugs , the stage of drug compliant behaviors mainly lay in maintenance .
5.In reinforcing factors , about the drug compliant behaviors , the numbers of those who had higher degree of social support were more than those who had lower degree of social support . They mainly lay in the stages of action and maintenance .
Based on the results of this study , I provide some suggestions for the future research , clinical medical care and administration as the reference to future research , medical attendants and administration .