高血壓病人用藥素養與用藥依從性之相關性探討

Abstract

本研究目的為探討高血壓病人之用藥素養與用藥依從性之相關性，為橫斷性研究，採便利性取樣，以台北市及新北市各鄰里社區三高篩檢站、里民活動中心為研究場域，收案對象為確診高血壓之成年病人，實際完成問卷之受試者為386人。問卷調查採用遵循醫囑領藥與使用藥品量表(Adherence to Refills and Medications Scale)、中文版用藥素養量表(Chinese Medication Literacy Measurement (ChMLM))作為測量工具，以多元線性迴歸分析分別探討影響用藥素養、用藥依從性的相關因素。在問卷調查研究結束後，獲取7位受試者同意，進行後續質性訪談，以深入探討可能影響用藥素養及用藥依從性之因素。研究結果如下：一、 研究對象之用藥素養平均得分為12.20分，答對率為71.8%，答對率最高為非處方藥項目85.6%，平均得分為4.28分，答對率最低為廣告藥品項目47%，平均得分為1.41分；用藥依從性總得分為18.04分，用藥依從度平均得分為11.46分，按時領藥遵從度為6.58分。二、 由多元線性迴歸分析得知，可預測用藥素養之背景變項為教育程度，教育程度為大學以上之受試者的ChMLM平均得分顯著高於教育程度為國小及國中之受試者。可預測用藥依從性之背景變項為年齡、是否有高血壓家族史、每日使用高血壓藥物次數、每日使用高血壓藥物顆數、自覺健康狀態。在年齡方面呈現負相關，即每增加一歲得分減少0.16分(β=-0.16, p<0.05 )；在家族史方面呈現正相關，有家族史之受試者得分顯著高於無家族史受試者(β=0.10, p<0.05 )；每日使用高血壓藥物次數使用兩次及三次受試者得分顯著高於使用一次受試者 (β=0.18, p<0.05 )；每日使用高血壓藥物顆數一顆以上受試者得分顯著高於一顆以下（含）受試者得分(β=0.16, p<0.05 )；自覺健康狀態普通、不好及很不好之受試者得分顯著高於自覺健康狀態很好及好(β=0.15, p<0.05 )。 三、 研究對象之用藥素養與用藥依從性沒有顯著相關性。 四、 根據質性訪談歸納出可能影響受試者用藥依從行為的因素包括：擔心未定期服藥會引起其他併發症、遵從醫師指示以及自發性健康管理。This study aimed to investigate the correlation between medication literacy and medication adherence in patients with hypertension. For the cross-sectional study, convenience sampling was used, and the study participants were recruited from communities in Taipei City and New Taipei City. The eligible participants were adult patients diagnosed with hypertension, and 386 participants completed the survey questionnaire.The Adherence to Refills and Medications Scale (ARMS) and the Chinese Medication Literacy Measurement (ChMLM) were used as the measurement tools for the quantitative study. Multiple linear regression analyses were conducted to investigate the factors associated with medication literacy and medication adherence. After the survey study, a subsequent qualitative study was conducted among 7 participants to explore the factors that might affect medication literacy and medication adherence. Study results are summarized below:1. The mean score of medication literacy of the study participants was 12.20, with a correct answer rate of 71.8%. The highest correct answer rate was 85.6% for over-the-counter items with an average score of 4.28, and the lowest correct answer rate was 47% for advertised items with an average score of 1.41. The mean score of overall ARMS was 18.04, and the average scores of refilling medications on schedule and taking medication as prescribed were 11.46 and 6.58, respectively.2. The regression analyses showed that the mean ChMLM scores of subjects with education level above university were significantly higher than those of subjects with education level of elementary and junior high school. Age was negatively associated with correlation with ARMS score (β=-0.16, p<0.05). Participants with family history of hypertension (β=0.10, p<0.05), those taking hypertension pill multiple times per day (β=0.18, p<0.05), those using more than one hypertension pill per day (β=0.16, p<0.05), and those who perceived poor health status (β=0.15, p<0.05) reported significantly higher ARMS score than their counterparts. 3. The regression models showed no significant correlation between medication literacy and medication adherence. 4. Based on the qualitative interviews, thefollowing factors which might affect participants’ medication adherence were summarized: fear of hypertension-related complications, adherence to doctor's recommendation, and self-initiated health management.