Park Hwa Yeon, Seo Sin Ae, Yoo Hyeyoung, Lee Kiheon
Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Community Health Research, Seongnam Center for Home Health Care, Seongnam, Republic of Korea.
Patient Prefer Adherence. 2018 Jan 24;12:175-181. doi: 10.2147/PPA.S151263. eCollection 2018.
The aim of this study was to assess medication adherence and its related factors among elderly people living alone with chronic diseases using a conceptual framework with the Belief about Medicines Questionnaire and the Adherence to Refills and Medication Scale-Korean version.
This was a cross-sectional study conducted in 3,326 elderly people living alone, who were enrolled in Seongnam Center for Home Health Care in South Korea. They completed validated questionnaires assessing their adherence and beliefs about medication in general.
In attitudinal analysis using Belief about Medicines Questionnaire, 37.0% of patients were accepting of medication (high necessity with low concerns), 49.7% were ambivalent (high necessity with high concerns), 1.9% were skeptical (low necessity with high concerns), and 11.4% were indifferent (low necessity and low concerns). In multivariable analysis, we found that adherence was related to patients' beliefs about medication; compared with patients who were accepting of medication, those in the other three attitudinal groups had significantly lower adherence (indifferent, =0.003; skeptical, =0.001; ambivalent, <0.001). Also, low adherence was associated with heavy burden of drug costs (β=0.109; 95% CI 0.03, 0.19), presence of drug side effects (β=0.431; 95% CI 0.11, 0.75), dissatisfaction with medication (β=-0.626; 95% CI -0.77, -0.48), perceiving health status as poor (β=-0.151; 95% CI -0.27, -0.03), and receiving medical aid (β=0.655; 95% CI 0.42, 0.89). Gender, age group, and number of prescribed medication were not associated with medication adherence.
To improve medication adherence of elderly living alone, it is essential to identify barriers to adherence, including their concerns and attitudes toward medications. These factors associated with adherence should be considered in further intervention studies.
本研究旨在使用包含药物信念问卷和韩国版续方及药物服用依从性量表的概念框架，评估患有慢性病的独居老年人的用药依从性及其相关因素。
这是一项横断面研究，对韩国城南居家医疗中心登记的3326名独居老年人进行了调查。他们完成了经过验证的问卷，以评估其总体用药依从性和用药信念。
在使用药物信念问卷进行的态度分析中，37.0%的患者接受用药（必要性高但担忧低），49.7%的患者态度矛盾（必要性高且担忧高），1.9%的患者持怀疑态度（必要性低但担忧高），11.4%的患者漠不关心（必要性低且担忧低）。在多变量分析中，我们发现依从性与患者的用药信念有关；与接受用药的患者相比，其他三个态度组的患者依从性显著较低（漠不关心，P = 0.003；持怀疑态度，P = 0.001；态度矛盾，P < 0.001）。此外，低依从性与药物费用负担重（β = 0.109；95%置信区间0.03，0.19）、药物副作用的存在（β = 0.431；95%置信区间0.11，0.75）、对药物的不满（β = -0.626；95%置信区间 -0.77，-0.48）、认为健康状况差（β = -0.151；95%置信区间 -0.27，-0.03）以及接受医疗救助（β = 0.655；95%置信区间0.42，0.89）有关。性别、年龄组和处方药数量与用药依从性无关。
为提高独居老年人的用药依从性，必须识别依从性的障碍，包括他们对药物的担忧和态度。在进一步的干预研究中应考虑这些与依从性相关的因素。
