第二型糖尿病患口服藥物服藥順應性相關因子之探討

Drug Adherence Factors for Type 2 Diabetic Patients

目的：探討影響第二型糖尿病患口服藥物順應性的相關因子，希望藉此提高此類病患醫療照護品質。方法：針對在某醫學中心家庭醫學科門診就診之第二型糖尿病患，且服用口服治療藥物滿6個月以上，有效個案共491位第二型糖尿病患；由專門訪談員以問卷調查的方式來了解病患服藥狀況。分析時將病患分為服藥順應性良好及順應性不良兩組，以比較兩組的可能相關因子的差異。結果：有效樣本中，口服降血糖藥物之服藥順應性良好者有320位（佔65.2%）。以多變項分析發現，年齡越大（勝算比：0.97；95%信賴區間：0.95~0.99）及病患自知服用降血糖藥種類小於3種者（勝算比：0.52；95%信賴區間：0.31~0.85），其口服藥物順應性較好，病患服用降血糖藥物小於5年者（勝算比：1.61；95%信賴區間：1.02~2.54），其口服藥物順應性較差。結論：臨床醫師在照顧第二型糖尿病患時，針對「服用降血糖藥物小於5年」或「服用降血糖藥物種類3種或以上」的病患給予關注與衛教，可能是一個提高這類病患服藥順應性的良好方式。

Objective: The purpose of the study was to investigate the factors associated with drug adherence in patients with type 2 diabetes mellitus, with the intention of improving the quality of medical care for patients. Methods: Four hundred and ninety one patients with type 2 diabetes mellitus, undergoing treatment at the family medicine outpatient department of a medical center in Taiwan receiving oral anti-diabetes agents for at least 6 months were enrolled in this study. One trained interviewer conducted interviews with all of the subjects using a structured questionnaire to assess the adherence of the patients to the prescribed treatment. Results: Sixty-five percent of the enrolled cases were defined as the adherence group when their adherence scores were 100%. According to the multivariate analysis, patients who had taken the anti-diabetes agents for less than 5 years had a poorer adherence (OR=1.61; 95% CI: 1.02-2.54); whereas, older patients and those using less than 3 anti-diabetes agents exhibited better adherence (OR=0.97 with 95% CI: 0.95-0.99 and OR=0.52 with 95% CI: 0.31-0.85, respectively). Conclusion: The authors demonstrate that three major factors were associated with adherence. In order to improve patients' adherence to the prescribed oral anti-diabetes treatment, the authors recommend that physicians pay more attention to the education of patients with type 2 diabetes mellitus who have been taking the prescribed medicine for less than 5 years and those who use more than 3 types of anti-diabetes agents.