高血压共病糖尿病患者服药依从性调查及影响因素分析

陈维尔; 邱艳; 潘晓华; 叶云; 任菁菁

doi:10.16766/j.cnki.issn.1674-4152.003460

高血压共病糖尿病患者服药依从性调查及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003460

陈维尔^{1, 2},
邱艳¹,
潘晓华²,
叶云³,
任菁菁^1, ,

1.
浙江大学医学院附属第一医院全科医疗科，浙江杭州 310003
2.
宁波市北仑区人民医院全科医学科，浙江宁波 315800
3.
宁波市北仑区人民医院药剂科

基金项目:

浙江省医学会临床科研基金项目 2020ZYC-A119

浙江省康恩贝医院管理软科学研究项目 2020ZHA-KEB323

详细信息

通讯作者:
任菁菁，E-mail: 3204092@zju.edu.cn

中图分类号: R544.1 R587.1
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- 文章访问数: 303
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- PDF下载量: 22
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-03
- 网络出版日期: 2024-05-29

Analysis of medication adherence and influencing factors in hypertensive patients combined with diabetes mellitus

CHEN Weier^{1, 2},
QIU Yan¹,
PAN Xiaohua²,
YE Yun³,
REN Jingjing^{1
, ,}

1.
Department of General Practice, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China

摘要

摘要: 目的了解高血压共病糖尿病患者服药依从性现状，并从社会人口学特征、生活行为方式、疾病资料方面探讨其影响因素。方法于2021年11月—2022年3月，在宁波市4家社区医院随机抽取高血压共病糖尿病患者共381例，参考中文版8条目Morisky服药依从性量表(MMAS-8)自行设计问卷进行调查。采用多因素logistic回归分析研究高血压共病糖尿病患者服药依从性的影响因素。结果 381例高血压共病糖尿病患者服药依从性得分为(5.67±1.05)分，依从性高者163例(42.78%)。单因素分析结果显示，高血压共病糖尿病患者服药依从性在性别、医疗付费方式、日服药种类、日服药次数以及是否饮酒方面比较，差异均有统计学意义(P < 0.05)。多因素logistic回归分析结果显示，使用城镇职工医保付费(OR=2.141, 95% CI: 1.346~3.405, P=0.001)的高血压共病糖尿病患者服药依从性较高，日服药次数≥3次(OR=0.438, 95% CI: 0.208~0.921, P=0.030)、日服药种类≥3种(OR=0.342, 95% CI: 0.216~0.540, P < 0.001)的高血压共病糖尿病患者服药依从性较低。结论高血压共病糖尿病患者服药依从性整体不高，其主要影响因素包括日服药次数、日服药种类、医保付费方式。应针对这些影响因素采取有效措施进行积极干预。
- 高血压 /
- 糖尿病 /
- 共病 /
- 服药依从性 /
- 影响因素
Abstract: Objective The study aimed to assess the medication compliance status in hypertensive patients combined with diabetes mellitus and to explore the influencing factors based on socio-demographic characteristics, lifestyle behaviors, and medical records. Methods Between November 2021 and March 2022, a total of 381 patients from four community hospitals in Ningbo were randomly selected as participants. They were surveyed using a questionnaire based on the Chinese version of the 8-item Morisky medication adherence scale (MMAS-8). Binary logistic analysis was used for data analysis. Results The average medication adherence score for 381 patients combined hypertension and diabetes mellitus was (5.67±1.05) points, with 163 patients (42.78%) demonstrating high adherence. Univariate analysis revealed that significant associations between medication adherence and various factors, including gender, medical payment methods, daily medication types, daily medication frequency, and alcohol consumption (P < 0.05). Multiple logistic regression revealed that patients with medical insurance for urban workers payment had higher medication compliance (OR=2.141, 95% CI: 1.346-3.405, P=0.001). Additionally, patients with a daily medication frequency of ≥3 (OR=0.438, 95% CI: 0.208-0.921, P=0.030) and those with daily medication types ≥3 (OR=0.342, 95% CI: 0.216-0.540, P < 0.001) exhibited lower medication compliance. Conclusion The medication compliance among patients with combined hypertension and diabetes mellitus is suboptimal, primarily influenced by factors such as daily medication frequency, daily medication types, and medical payment methods. Therefore, proactive interventions should be implemented based on these influencing factors.
- Hypertension /
- Diabetes mellitus /
- Multimorbidity /
- Medication adherence /
- Influencing factors

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表 1 高血压共病糖尿病患者服药依从性的单因素分析[例(%)]

Table 1. Univariate analysis of medication adherence in hypertensive patients combined with diabetes mellitus[cases(%)]

项目	例(%)	依从性高 (n=163)	依从性低 (n=218)	统计量	P值
性别				5.772^a	0.016
男性	179(46.98)	65(36.31)	114(63.69)
女性	202(53.02)	98(48.51)	104(51.49)
年龄(岁)				-0.402^b	0.687
< 50	23(6.04)	14(60.87)	9(39.13)
50~64	133(34.91	53(39.85)	80(60.15)
≥65	225(59.06)	96(42.67)	129(57.33)
婚姻情况				0.078^a	0.780
已婚	350(91.86)	149(42.57)	201(57.43)
单身	31(8.14)	14(45.16)	17(54.84)
居住情况				0.003^a	0.960
非独居	355(93.18)	152(42.82)	203(57.18)
独居	26(6.82)	11(42.31)	15(57.69)
文化程度				-1.040^b	0.298
小学及以下	169(44.36)	71(42.01)	98(57.99)
初中	164(43.04)	64(39.02)	100(60.98)
中专/高中及以上	48(12.60)	28(58.33)	20(41.67)
医疗付费方式				7.571^a	0.006
城镇职工医保	191(50.13)	95(49.74)	96(50.26)
城乡居民医保	190(49.87)	68(35.79)	122(64.21)
工作情况				0.002^a	0.962
在职	108(28.35)	46(42.59)	62(57.41)
非在职	273(71.65)	117(42.86)	156(57.14)
家庭人均月收入(元)				-0.533^b	0.594
< 1 000	18(4.72)	9(50.00)	9(50.00)
1 000~3 000	193(50.66)	83(43.01)	110(56.99)
3 001~5 000	113(29.66)	48(42.48)	65(57.52)
>5 000	57(14.96)	23(40.35)	34(59.65)
吸烟				0.275^a	0.600
无	299(78.48)	130(43.48)	169(56.52)
有	82(21.52)	33(40.24)	49(59.76)
饮酒				8.826^a	0.003
无	284(74.54)	134(47.18)	150(52.82)
有	97(25.46)	29(29.90)	68(70.10)
经常运动				2.841^a	0.092
有	152(39.90)	73(48.03)	79(51.97)
无	229(60.10)	90(39.30)	139(60.70)
均衡膳食				1.468^a	0.226
有	268(70.34)	120(44.78)	148(55.22)
无	113(29.66)	43(38.05)	70(61.95)
日服药种类(种)				32.668^a	< 0.001
≤2	181(47.51)	105(58.01)	76(41.99)
≥3	200(52.49)	58(29.00)	142(71.00)
日服药次数(次)				-5.218^b	< 0.001
1	43(11.29)	25(58.14)	18(41.86)
2	156(40.94)	86(55.13)	70(44.87)
≥3	182(47.77)	52(28.57)	130(71.43)
慢性病诊断年限(年)				-1.131^b	0.258
≤3	55(14.44)	27(49.09)	28(50.91)
4~6	59(15.49)	28(47.46)	31(52.54)
7~9	93(24.41)	37(39.78)	56(60.22)
≥10	174(45.67)	71(40.80)	103(59.20)
注：^a为χ²值，^b为Z值。

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表 2 高血压共病糖尿病患者服药依从性的多因素logistic回归分析

Table 2. Multiple logistic regression analysis of medication adherence in hypertensive patients combined with diabetes mellitus

变量	B	SE	Waldχ²	P值	OR值	95% CI
性别	-0.489	0.282	3.008	0.083	0.613	0.353~1.066
医疗付费方式	0.761	0.237	10.338	0.001	2.141	1.346~3.405
饮酒	-0.506	0.328	2.377	0.123	0.603	0.317~1.147
日服药种类	-1.074	0.234	21.127	< 0.001	0.342	0.216~0.540
日服药次数
2次	0.213	0.376	0.321	0.571	1.237	0.592~2.585
≥3次	-0.825	0.379	4.733	0.030	0.438	0.208~0.921
注：各变量分别以性别为女性、医疗付费方式为城乡居民医保、饮酒为否、日服药种类为≤2种、日服药次数为1次作为参照。

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参考文献(22)

[1]	陈维尔, 邱艳, 潘晓华, 等. 我国共病患者服药依从性的研究进展[J]. 中华全科医学, 2023, 21(10): 1745-1748. doi: 10.16766/j.cnki.issn.1674-4152.003215 CHEN W E, QIU Y, PAN X H, et al. Progress on medication compliance of patients with multimorbidity in China[J]. Chinese Journal of General Practice, 2023, 21(10): 1745-1748. doi: 10.16766/j.cnki.issn.1674-4152.003215
[2]	豆丽园, 黄娟, 叶森, 等. 社区老年慢性病共存患者治疗负担现状及影响因素研究[J]. 中国全科医学, 2021, 24(13): 1671-1675. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202113015.htm DOU L Y, HUANG J, YE S, et al. Treatment Burden and Influencing Factors of Elderly Patients with Multimorbidity in the Community[J]. Chinese General Practice, 2021, 24(13): 1671-1675. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202113015.htm
[3]	杨直, 高静, 柏丁兮, 等. 老年慢性病共病患者治疗负担体验的质性研究[J]. 中国全科医学, 2022, 25(19): 2336-2341. doi: 10.12114/j.issn.1007-9572.2022.0169 YANG Z, GAO J, BAI D X, et al. Experience of treatment burden in older adults with multimorbidity: a qualitative study[J]. Chinese General Practice, 2022, 25(19): 2336-2341. doi: 10.12114/j.issn.1007-9572.2022.0169
[4]	张强, 王长远, 李一凡. 老年慢性病共病患者抑郁焦虑状况及影响因素[J]. 安徽医学, 2023, 44(3): 257-261. doi: 10.3969/j.issn.1000-0399.2023.03.003 ZHANG Q, WANG C Y, LI Y F. Analysis of depression anxiety and influencing factors in elderly patients with chronic comorbidity[J]. Anhui Medical Journal, 2023, 44(3): 257-261. doi: 10.3969/j.issn.1000-0399.2023.03.003
[5]	MAIR A, WILSON M, DREISCHULTE T. Addressing the challenge of Polypharmacy[J]. Annu Rev Pharmacol Toxicol, 2020, 60: 661-681. doi: 10.1146/annurev-pharmtox-010919-023508
[6]	姚元龙, 史威力, 冯娴, 等. 老年共病的研究管理策略[J]. 中华全科医学, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574 YAO Y L, SHI W L, FENG X, et al. Research management strategies for multimorbidity in elderly patients[J]. Chinese Journal of General Practice, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574
[7]	范潇茹, 陈莎, 施予宁, 等. 我国中老年人慢性病共病现状及其对卫生服务利用和医疗费用的影响研究[J]. 中国全科医学, 2022, 25(19): 2371-2378. doi: 10.12114/j.issn.1007-9572.2022.0220 FAN X R, CHEN S, SHI Y N, et al. Multimorbidity prevalence and its association with health service utilization and medical costs among middle-aged and older Chinese people[J]. Chinese General Practice, 2022, 25(19): 2371-2378. doi: 10.12114/j.issn.1007-9572.2022.0220
[8]	ZHANG Y Q, LI Y, DONG Y G, et al. A nationwide assessment of blood pressure control and the associated factors in Chinese type 2 diabetes mellitus patients[J]. J Clin Hypertens(Greenwich), 2019, 21(11): 1654-1663. doi: 10.1111/jch.13675
[9]	王登炜, 方欣, 杨泽, 等. 福建省35~75岁居民高血压合并糖尿病流行现况及影响因素[J]. 中华高血压杂志, 2023, 31(5): 461-464. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202305011.htm WANG D W, FANG X, YANG Z, et al. Prevalence and influencing factors of hypertension combined with diabetes among population aged 35-75 years in Fujian Province[J]. Chinese Journal of Hypertension, 2023, 31(5): 461-464. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202305011.htm
[10]	谭兰兰, 雷玉华. 高血压合并2型糖尿病患者残余胆固醇与血压变异性的相关性分析[J]. 中国医药, 2022, 17(10): 1468-1472. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202210007.htm TAN L L, LEI Y H. Correlation between residual cholesterol and blood pressure variability in hypertensive patients with type 2 diabetes mellitus[J]. China Medicine, 2022, 17(10): 1468-1472. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202210007.htm
[11]	张振香, 何福培, 张春慧, 等. 慢性病共病患者服药依从性潜在类别及其影响因素分析[J]. 中国全科医学, 2022, 25(31): 3904-3913. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202231010.htm ZHANG Z X, HE F P, ZHANG C H, et al. Latent class analysis and influencing factors of medication adherence in multiple chronic conditions patients[J]. Chinese General Practice, 2022, 25(31): 3904-3913. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202231010.htm
[12]	田勇, 张楠, 杨正强, 等. 北京市怀柔区"五维一体"慢病管理模式的效果分析[J]. 北京医学, 2023, 45(4): 294-298, 303. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202304004.htm TIAN Y, ZHANG N, YANG Z Q, et al. Analysis of management effect of "five-dimensional integration" chronic disease management model in Huairou district of Beijing[J]. Beijing Medical Journal, 2023, 45(4): 294-298, 303. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202304004.htm
[13]	JÜNGST C, GRǍBER S, SIMONS S, et al. Medication adherence among patients with chronic diseases: a survey-based study in pharmacies[J]. QJM, 2019, 112(7): 505-512. doi: 10.1093/qjmed/hcz058
[14]	KIM S, BENNETT K, WALLACE E, et al. Measuring medication adherence in older community-dwelling patients with multimorbidity[J]. Eur J Clin Pharmacol, 2018, 74(3): 357-364. doi: 10.1007/s00228-017-2388-y
[15]	姚媛英. 社区老年共病患者服药依从性及影响因素研究[D]. 开封: 河南大学, 2018. YAO Y Y. The study on medication adherence adherence and influencing factors of community elderly patients with comorbidity[D]. Kaifeng: Henan University, 2018.
[16]	缪琴, 刘竟芳. 长沙市城区老年慢性病患者服药依从性影响因素研究[J]. 中南药学, 2019, 17(10): 1783-1787. https://www.cnki.com.cn/Article/CJFDTOTAL-ZNYX201910045.htm MIAO Q, LIU J F. Influence factors for medication compliance in elderly patients with chronic diseases in Changsha[J]. Central South Pharmacy, 2019, 17(10): 1783-1787. https://www.cnki.com.cn/Article/CJFDTOTAL-ZNYX201910045.htm
[17]	向富森, 王佩佩, 赵治红, 等. 西安地区慢性病患者服药依从性调查及影响因素研究[J]. 华南预防医学, 2022, 48(9): 1146-1149. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF202209029.htm XIANG F S, WANG P P, ZHAO Z H, et al. Compliance and its influencing factors of patients with chronic diseases in Xi'an[J]. South China Journal of Preventive Medicine, 2022, 48(9): 1146-1149. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF202209029.htm
[18]	保琦, 罗震寰, 翟琛琛, 等. 我国6省7家县级公立医院高血压患者用药依从性及影响因素研究[J]. 中国药事, 2021, 35(2): 206-214. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYS202102013.htm BAO Q, LUO Z H, ZHAI C C, et al. Research on medication adherence and impact factors of hypertension patients in 7 county-level public hospitals in 6 provinces in China[J]. Chinese Pharmaceutical Affairs, 2021, 35(2): 206-214. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYS202102013.htm
[19]	李立荣. 社区慢性病患者服药依从性的调查及对策[J]. 中国社区医师, 2022, 38(2): 7-9. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS202202003.htm LI L R. Investigation and countermeasures on medication compliance of chronic disease patients in community[J]. Chinese Community Doctors, 2022, 38(2): 7-9. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS202202003.htm
[20]	田雪莹, 张丙银, 侯家祥, 等. 山东省农村地区高血压患者服药依从性影响因素研究[J]. 预防医学论坛, 2020, 26(10): 732-735. https://www.cnki.com.cn/Article/CJFDTOTAL-YXWX202010006.htm TIAN X Y, ZHANG B Y, HOU J X, et al. Study on influencing factors of medication compliance among hypertension patients in rural areas, Shandong province[J]. Preventive Medicine Tribune, 2020, 26(10): 732-735. https://www.cnki.com.cn/Article/CJFDTOTAL-YXWX202010006.htm
[21]	余灵芝, 袁红梅. 维持性血液透析合并高血压患者降压药服药依从性及影响因素分析[J]. 中国慢性病预防与控制, 2020, 28(10): 770-773. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202010016.htm YU L Z, YUAN H M. Analysis of antihypertensive medication compliance and influencing factors in patients with maintenance hemodialysis combined with hypertension[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2020, 28(10): 770-773. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202010016.htm
[22]	WORMALL S, ABBOT S. Primary care clinical pharmacists and chronic disease medication adherence[J]. Br J Gen Pract, 2021, 71(712): 496. DOI: 10.3399/bjgp21X717485.