急性感染病人抗生素服藥遵從性及其影響因素之研究

Factors Influencing Adherence to Antibiotic Therapy in Patients with Acute Infections

背景：服用抗生素的時間和劑量要符合醫師處方才能維持穩定的藥物血中濃度，進而發揮最佳滅菌或抑菌的效果與減少產生細菌抗藥性的機會。有鑑於抗藥性菌種問題日益嚴重，衛生服利部在醫院中積極推動抗生素使用的合理性、電腦管制抗生素的使用量等，卻忽略了門診病人在抗生素的使用上是否正確，國外研究顯示抗生素服藥不遵從是導致抗藥性菌種問題的主因之一，然而台灣關於抗生素服藥遵從性的研究少，且抗藥性菌種問題嚴重，故引發作者探討感染科門診就診之急性感染病人服用抗生素的遵從性及其影響因素之動機，以作為日後改善抗生素服藥遵從性的參考。目的：本研究目的為(1)描述急性感染門診病人服用抗生素的遵從情形，(2)探討影響服用抗生素遵從性的因素，包括人口學、疾病特性與抗生素服藥知識。方法　採描述性相關研究設計，以因急性感染服用抗生素之門診病人為研究對象，採方便取樣，共招募162位符合收案條件之病人參與本研究，以結構式問卷進行資料收集，以Chi-square test、Mann-Whitney U test和logistic regression進行資料分析。結果　研究結果顯示因急性感染接受抗生素短期治療之門診病人按醫囑服用抗生素的遵從度不高，在平均5天的抗生素療程中，僅有40.1%的病人完全遵從醫囑服用抗生素。不遵從者在抗生素效果面向的知識得分較遵從者低（U=2654.5, p=.046）。邏輯式回歸結果顯示抗生素效果面向的知識為不遵從服藥的重要預測子（B=.481, p=.046）。結論　不同於醫護人員的預期，因急性感染接受短期抗生素治療的病人，未遵從醫囑服藥的情形是很普遍的。此一發現提醒醫護人員即便是治療因急性感染短期接受抗生素治療之門診病人，亦應加強抗生素相關衛教，特別是抗生素效果面向有關的抗生素知識，進而增加病人之服藥遵從性。

Background: Taking antibiotics in strict adherence to physician prescriptions is crucial for maintaining the stability of the drug concentration in the blood and for achieving the best therapeutic effects. The increasing antimicrobial resistance in recent decades has led the Ministry of Health and Welfare to promote the rational use of antibiotics and the use of a computer monitoring system to control the use of antibiotics in hospitals. Although non-adherence is considered as the major factor contributing to antimicrobial resistance, patient non-adherence to antibiotic prescriptions is an issue that has been largely overlooked. This paper explores this issue due to the serious threat from antimicrobial resistance and the few studies that have investigated patient adherence to antibiotic treatments for acute infections in Taiwan. Purpose: The aims of the study include: (1) describe patient's adherence to antibiotic therapy for acute infections and (2) explore the potential factors of influence on antibiotic adherence such as demographics, disease characteristics, and knowledge of antibiotic treatment. Methods: The study used a descriptive correlational design. A convenience sample of 162 patients with acute infections was recruited from outpatient infectious disease clinics in Taoyuan City. Data were collected using the study questionnaire and analyzed using the chi-square test, Mann-Whitney U test, and logistic regression. Results: The study results showed that only 40.1% of patients followed their prescription to take antibiotics completely. The remainder earned lower scores than their prescription-adhering counterparts for knowledge regarding the effects of antibiotics (U=2654.5, p=.046). Results of logistic regression showed that knowledge regarding the effects of antibiotics was the most significant predictor (B=.481, p=.046) of adherence to antibiotic therapies. Conclusion: Non-adherence to prescriptions is prevalent in short-term antibiotic treatments prescribed for acute infections. This finding reminds healthcare providers to provide proper education to the recipients of antibiotic treatments, even those treated for a very short duration for acute infections in outpatient settings. Special attention should be pay to enhancing the understanding and appreciation of patients for the therapeutic effects of antibiotics.