急性心肌梗死患者药物依从性、生活方式改变与健康相关生活质量的关系：一项横断面研究。
Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study.
机构信息
Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, South Korea.
出版信息
Health Qual Life Outcomes. 2018 May 22;16(1):100. doi: 10.1186/s12955-018-0921-z.
BACKGROUND
The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients.
METHODS
A cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview.
RESULTS
In the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5-91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4-93.3).
CONCLUSIONS
Adherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes.
背景
健康依从者效应是指患者坚持医疗治疗往往会寻求健康行为的现象。尽管健康依从者效应被认为会影响冠心病患者的健康结果，但评估其存在和程度并不容易。本研究旨在评估急性心肌梗死（AMI）后患者的药物依从性与生活方式改变与健康相关生活质量之间的关系。
方法
这是一项横断面研究，纳入了 2015 年 12 月至 2016 年 3 月在韩国 11 所大学医院接受经皮冠状动脉介入治疗（PCI）的 417 名 AMI 后患者。通过一对一访谈调查了社会人口统计学因素、六项健康行为（低盐摄入、低脂饮食和/或减肥饮食、规律运动、日常生活减压、适度饮酒和戒烟）、使用改良 Morisky 量表（MMS）评估的药物依从性以及使用冠状动脉血运重建结局问卷（CROQ）评估的健康相关生活质量的详细信息。
结果
在单变量逻辑分析中，性别（女性）、年龄（≥70 岁）、MMS 评分（≥5）和 CROQ 评分与生活方式改变的依从性相关。在多变量逻辑分析中，在校正性别、年龄、婚姻状况、教育程度和家庭收入后，MMS 评分高（≥5）与生活方式改变的依从性相关（调整后的比值比[OR] = 11.7，95%置信区间[CI] = 1.5-91.3）。在进一步调整 CROQ 评分后，MMS 评分高与生活方式改变的依从性之间的关联仍然显著（调整后的 OR = 11.5，95% CI = 1.4-93.3）。
结论
药物依从性与生活方式改变的依从性相关，这表明 AMI 后患者可能存在健康依从者效应。在校正健康相关生活质量后，这种关联仍然存在。为了改善 AMI 后患者的健康结果，早期发现药物和生活方式改变依从性差的患者，并开展提高依从性的动机教育计划非常重要。此外，在临床研究中，特别是在评估治疗对健康结果影响的研究中，应考虑健康依从者效应。
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