因應資源、因應副作用、控制與醫囑遵循的關係

THE RELATIONSHIP AMONG COPING RESOURCES, COSTS OF COPING, CONTROL AND MEDICAL ADHERENCE

醫囑遵循的研究已由病人的服從性及忠誠性的觀念轉為強調在醫療過程中的選擇性及相互性，因此病人會不會遵循醫囑是經由其判斷所作的決定。本研究視醫囑遵循是一因應的過程，因此病人在此因應的過程中，如果評估他擁有的個人、家庭及醫療資源愈多時，且評估於因應此疾病所帶來的副作用愈少時，其醫囑遵循行為愈高。另外，本研究假設病人如果覺得仰賴自己或仰賴醫護人員可提高對疾病的控制感，其醫囑遵循亦較高。本研究以罹患高血壓的14位初診及27位複診病人，罹患糖尿病的4位初診及5位複診的病人，及同時罹患高血壓及糖尿病的2位初診及9位複診病人為受試者。研究結果指出醫囑遵循高組的病人比醫囑遵循低組的病人，顯著地覺得他擁有較多的因應資源，且較不覺得醫療過程會有較多的因應副作用，並對疾病有較高的控制感。經由逐步迴歸分析的結果顯示，「因應資源」「醫療醫控程度」、及「因應副作用」對醫囑遵循較具影響力。本研究最後建議增加病人對醫療的信任、加強衛教課程來提昇病人的生活管理，以及醫療人員注意病人因應資源的多寡及因應疾病的副作用，將可提昇病人的醫囑遵循。

The study of medical adherence has shifted it's emphasis from the compliance and loyalty of patients to the selectivity and mutuality in the treatment process. It is patients who decide whether to follow the doctor's suggestions. This study propose that medical adherence is a coping process. During the process of coping, patients' behaviors of medical adherence would increase if they assess they have more personal, family and medical resources; and if they assess there is the least cost in the coping process. The other hypothesis of this study is that if patients feel that they can rely on themselves or medical staff to control illness, their medical adherence would increase. Data of 14 first-vi sit and 27 follow-up-visit patients with high blood pressure, 4 first-visit and 5 follow-up-visit patients with diabetes, as well as 2 first-visit and 9 follow-up-visit patients with both high blood pressure and diabetes are collected. The result indicates that the group with higher medical adherence have more control than the group with lower medical adherence over illness, treatment modalities, and other arrangements in their life. The group with higher medical adherence also have more coping resources, and have fewer impressions of any cost in the coping process. It emerges clearly from step-wise regressional analysis that 'coping resources', 'medical staffs control treatment' and 'costs of coping' have the most effect on medical adherence. This study suggests that increase the trust of medical treatment, provide psychoeducational program to promote the patient's life-management by himself, and medical staffs concern patient's coping resources and costs of coping, then patient's medical adherence will be higher.