某醫學中心家醫科門診三高病患藥物順應性相關因子分析

Factors Affecting Adherence to Medications for Hypertension, Diabetes Mellitus and Dyslipidemia at Family Medicine Clinic in a Medical Center

目的：高血壓、糖尿病（高血糖）、高血脂等三高疾病是基層醫療最常見的慢性病，需要長時間藥物治療以減少心血管疾病之風險。但三高病患的藥物順應性差，因而導致控制率不佳。故本研究計量台灣三高病患的藥物順應性，並找出影響的相關因子，期望對於台灣三高的控制率能有所貢獻。方法：以北部某醫學中心家醫科門診看診，且接受至少三個月藥物治療之三高病患，共140位為研究對象，填寫結構式問卷和中文版Morisky score量表，其有效問卷為131份。依照量表區分為藥物順應性良好和不良兩組，比較兩組閒可能相關因子的差異。結果：有效問卷中，男性80人(61.1%)，女性51人(38.9%)。平均年齡為56.3±11.7歲。依據Morisky score的計量，高血壓、糖尿病以及高血脂病患有良好藥物順應性比率分別為35.1%、11.5%、和26.7%。複邏輯回歸分析顯示65歲以上的高血壓與高血脂病患比小於65歲者有較好的藥物順應性，達統計學上之顯著差異；勝算比分別為3.4及9.7。其餘變項與藥物順應性的相關性則無顯著差異。結論：臨床醫師針對年齡小於65歲之高血壓和高血脂病患，給予加強藥物順應性相關衛教，可能是提高這類病患藥物順應性的良好方式之一。

Purpose: In primary care settings, hypertension, diabetes mellitus, and dyslipidemia are the most common chronic diseases requiring medication control to reduce the risk of cardiovascular events. Patient adherence to these regimens is generally low and this results in poor control of these chronic diseases. The objectives of this study were to measure patients' adherence to these medications and to identify factors associated with medication adherence in family practice. Methods: Data were collected from patients who had hypertension, diabetes mellitus, or dyslipidemia, and received medication for at least 3 months at the Family Medicine Outpatient Department of a medical center in Taiwan. A total of 131 subjects completed a structured questionnaire and the Chinese edition of the Morisky scale to evaluate medication adherence. Subjects were classified as adherent and non-adherent based on a Morisky score of 4 or less than 4, respectively. Multiple logistic regression analysis was used to identify the risk factors for medication non-adherence. Results: Of 131 patients, 98 had hypertension, 46 diabetes mellitus, and 53 dyslipidemia. The average age of the participants was 56.3±11.7 years, and 61% were male. Patients with hypertension, diabetes mellitus, and dyslipidemia had a medication adherence rate of 35.1%, 11.5% and 26.7%, respectively. Based on multivariate analysis, patients aged 65 or older with hypertension or dyslipidemia had a better adherence rate than did younger patients (OR=3.4 and 9.7, respectively). Other factors did not reach statistical significance. Conclusion: To improve patients' adherence, physicians should pay more attention to the education of younger patients (age < 65) with hypertension and dyslipidemia.