社區中老年人用藥安全知識、態度和行為之探討

A Study on the Knowledge, Attitude and Practice of Safe Medication Use among Middle-Aged and Elderly Community Dwellers

目的：中老年人常合併多種急慢性疾病和多重藥物使用，對藥物的知識、態度和使用不適當，會增加藥物傷害的風險；本研究目的為探討社區中老年人用藥安全知識、態度和行為及其相關因素。方法：採橫斷式研究，邀請參與台南市社區健康促進活動之年滿45歲以上之中老年民眾，以結構式問卷調查其用藥安全知識、態度和行為。結果：在627位活動參與者中回收590份有效問卷（回收率為94.1%）。參加調查的590位社區民眾中女性佔69.7%、53.2%為老年、32.6%具高中（職）學歷、57.3%目前無職業、63.1%參加者個人月收入低於2萬元、已婚者佔97.1%而與配偶及直系親屬同住者佔57.6%，此外有55.3%罹患慢性病、73.7%有常規運動，和60.8%每日攝取五蔬果。用藥安全知識、態度和行為平均分數（得分百分比）依次為15.3分(80.3%)、16.7分(66.7%)和50.8分(79.4%)。有適當的用藥安全知識、態度和行為的受訪者分佔59.2%、19.8%和51.7%。由迴歸模式分析發現較年輕、服用保健食品、和個人月收入高者，為用藥安全知識適當的顯著相關因素；用藥安全知識適當與未使用中/草藥，與用藥安全態度適當有顯著相關；而用藥安全行為適當，則和用藥安全態度適當、常規運動習慣及無使用保健食品有顯著相關。結論：社區中老年人用藥安全知識與其態度、或態度與其行為呈顯著相關。不過研究受訪者的用藥安全知識、態度、和行為適當的比例偏低，尤其是用藥安全態度。未來專業人員仍需透過用藥安全衛教加強中老年民眾用藥安全行為，並考量服務對象之特性擬定策略。

Purpose: High rates of comorbidity and polypharmacy are common among the middle-aged and elderly population, thus raising the risk of adverse drug events among persons without appropriate knowledge, attitude and practice (KAP) of medication safety. The purpose of the study is to examine the factors affecting the KAP of safe medication use among middle-aged and senior community dwellers. Methods: This cross-sectional study found its subjects in participants aged 45 year or over in the community health promotion programs in Tainan City. Information was collected using a structured questionnaire. Results: Of the 627 subjects recruited, 590 (94.1%) completed the questionnaire. Most participates were female (69.7%), elderly (53.2%), with a high school or a vocational school diploma (32.6%), unemployed (57.3%), with a monthly income lower than $20,000 (63.1%), married (97.1%), and living with spouse or immediate family (57.6%). Respectively 55.3%, 73.7%, 60.8% of the participants had chronic diseases, practiced regular exercise, and ate more than 5 kinds of vegetables and fruits daily. The medication safety KAP average scores were respectively 15.3 points (80.3%) for “knowledge,” 16.7 points (66.7%) for “attitude,” and 50.8 points (79.4%) for “practice.” 59.2% of the participants appeared to have adequate knowledge, 19.8% a positive attitude, and 51.7% proper practice of medication safety. Adequate knowledge of medication safety was significantly associated with younger age, dietary supplement use, and higher personal income. Positive attitude toward safe medication use was significantly associated with adequate knowledge and use of no Chinese/herbal remedies. Positive attitude, regular exercise, and use of no dietary supplement were independently associated with appropriate practice of medication safety. Conclusion: With respect to safe medication use among middle-aged and elderly community dwellers, knowledge appears to be significantly associated with attitude which in turn is significantly related to practice. The study results indicate a general lack of adequate knowledge, positive attitude, and proper practice concerning medication safety in the interviewed participants. Health personnel still need to develop more effective education programs and teaching strategies to improve safe medication use in the middle-aged and elderly population.