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北京市怀柔区社区严重精神障碍患者免费服药 依从性相关因素分析
姜涛王智民郭志华祁娜马来福王宏杰谭立萍韩天夏立杰刘国帅 刘博刘欣然郑旭马超宋丽敏张玉侠
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摘要:
目的 探索了解北京市怀柔区社区居家严重精神障碍患者免费服药依从性的相关因素。 方法 采用简单随机抽样的方法,对 2018 年 3 月至 2019 年 3 月期间,登记在“北京市怀柔区精神卫生管 理系统”的社区免费服药的严重精神障碍患者 600 例进行 Morisky 自我报告服药依从性问卷(MAQ-8)调 查,依据调查情况分为依从性差(MAQ-8 得分< 6 分)组与依从性好(MAQ-8 得分 6~8 分)组。收集所有 对象的一般特征(性别、年龄、工作情况、居住环境、婚姻状态、居住方式、躯体疾病、家族史、药敏史、疾 病类型、家庭收入、受教育年限、住院次数等)以及影响服药依从性的因素。采用访谈法对 15 例严重精 神障碍患者进行个案访谈,通过现象学分析法对资料进行分析,得到影响服药依从性的 9 个主题;采用 t检验和χ2 检验分析依从性差组与依从性好组患者一般特征的差异,采用多因素 Logistic 回归分析方法 分析影响患者依从性的因素。结果 本次研究共筛查 600 例,采集有效信息 435 例,其中 325 例(74.7%) 服药依从性好,110 例(25.3%)服药依从性差;未按医嘱服药的原因中,选择率最高者为忘记服用(60.0%, 66/110),其次为无监护人管理督促(43.6%,48/110)和自知力缺乏(35.5%,39/110)。多因素 Logistic 回归 分析结果显示,居住环境在平原区的患者服药依从性劣于山区的患者(OR=2.41,95%CI:1.14~5.10,P< 0.05);家庭月收入< 3 000 元的患者服药依从性优于家庭月收入≥ 5 000 元的患者(OR=0.36,95%CI: 0.19~0.70,P< 0.01);受教育程度低是服药依从性的危险因素(OR=13.81,95%CI:2.82~67.7,P< 0.01)。 结论 北京市怀柔区的居家免费服药的严重精神障碍患者中,居住环境、家庭月收入、受教育年限是影 响依从性的主要影响因素。未按医嘱服药的原因主要为各种原因忘记服用,其次为无监护人管理督促 而未服药和自知力缺乏。
关键词:  精神障碍  药物  依从性  免费服药
DOI:10.3969/j.issn.1009-6574.2020.12.003
基金项目:北京市怀柔区卫生健康委员会基金(2017-A-001)
Analysis of factors associated with free medication compliance in community-based patients with severe mental disorders in Huairou District of Beijing
Jiang Tao, Wang Zhimin, Guo Zhihua, Qi Na, Ma Laifu, Wang Hongjie, Tan Liping, Han Tian, Xia Lijie, Liu Guoshuai, Liu Bo, Liu Xinran, Zheng Xu, Ma Chao, Song Limin, Zhang Yuxia
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Abstract:
Objective To explore the factors associated with free medication compliance in communitybased patients with severe mental disorders at home in Huairou District of Beijing. Methods A total of 600 patients with severe mental disorders who were registered in the Beijing Huairou Mental Health Management System from March 2018 to March 2019 were selected by simple random sampling method, and investigated by Morisky Adherence Questionnaire (MAQ-8). According to the results of the survey, patients were divided into poor compliance group (MAQ-8 score less than 6) and good compliance gourp (MAQ-8 score between 6 and 8). The general characteristics (gender, age, working condition, living environment, marital status, living style, physical disease, family history, history of drug allergy, disease type, family income, education attainment, hospitalization times, etc.) and the factors influencing medication compliance were collected. 15 patients with severe mental disorders were interviewed, and the data were analyzed by phenomenological analysis. 9 themes affecting medication compliance were identified. T-test and Chi-square test were used to analyze the differences of general characteristics between the poor compliance group and the good compliance group. Multivariate logistic regression analysis was used to analyze the factors influencing the compliance. Results In this study, a total of 600 cases were screened and 435 cases of effective information were collected, among which 325 cases (74.7%) had good medication compliance and 110 cases (25.3%) had poor medication compliance. Among the reasons for not taking prescribed medication, the highest choice rate was forgetting to take medicine (60.0%, 66/110), followed by lack of supervision (43.6%, 48/110) and lack of insight of the disease (35.5%,39/110). Multivariate logistic regression analysis showed that the medication compliance of patients living in plain area was worse than that of patients living in mountainous area (OR=2.41, 95%CI:1.14-5.10,P < 0.05); the medication compliance of patients with monthly family income less than 3000 yuan was better than that of patients with monthly family income more than 5 000 yuan (OR=0.36,95%CI: 0.19-0.70,P < 0.01); low education level was a risk factor for medication compliance (OR=13.81,95%CI:2.82-67.7,P < 0.01). Conclusions Among the patients with severe mental disorders taking free medication in the community in Huairou District of Beijing, living environment, monthly household income, and education attainment are the main influencing factors of compliance. The reasons for not taking medication as prescribed include forgetting to take medication for various reasons, not taking medication without supervision of a guardian and lack of insight.
Key words:  Severe mental disorder  Medication  Compliance  Free medication

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