Nasir N M, Ariffin F, Yasin S M
Universiti Teknologi MARA, Faculty of Medicine, Primary Care Department, Selayang campus, Batu Caves, Selangor, Malaysia.
Universiti Teknologi MARA, Faculty of Medicine, Maternal Fetal & Embryo Research Core (MatE), Sungai Buloh, Selangor, Malaysia.
Med J Malaysia. 2018 Jun;73(3):163-169.
Medication adherence has been found to be an important determinant in achieving glycaemic control in Type 2 Diabetes (T2DM) patients. In other patient populations, physician-patient interaction satisfaction was found to influence medication adherence. It is then important to identify if this is also a factor amongst T2DM patients on insulin as poor adherence was associated with increased all-cause mortality.
This was a cross sectional study involving 197 T2DM patients on insulin from two government primary health clinics in Gombak. Physician-patient interaction satisfaction was assessed using Skala Kepuasan Interaksi Perubatan (SKIP-11) consisting of 3 subdomains (Distress Relief, Rapport and Interaction Outcome). Medication adherence level was measured using a single item selfreport question. Data analysis for descriptive, inferential and multivariate analysis statistics were performed.
The mean age of the study participants was 57.12 (SD: 9.27). Majority were Malay, female, unemployed with mean BMI of 27.5. Majority reported full adherence (62.9%). High scores in the Interaction Outcome subdomain was associated with better adherence. Factors associated with high scores in this subdomain included patient education level, number of oral hypoglycaemic agent and type of insulin regime taken. This study also found that high scores in the Interaction Outcome domain is associated with lower HbA1c (p<0.05).
Physician-patient interaction satisfaction is an important factor in achieving better medication adherence which also leads to better glycaemic control in this group of patients. There is a need to identify strategies to improve satisfaction in this domain to improve patient adherence.
在2型糖尿病（T2DM）患者中，药物依从性是实现血糖控制的一个重要决定因素。在其他患者群体中，医患互动满意度被发现会影响药物依从性。鉴于依从性差与全因死亡率增加相关，因此确定这在使用胰岛素的T2DM患者中是否也是一个因素很重要。
这是一项横断面研究，涉及来自哥打峇鲁两家政府初级保健诊所的197名使用胰岛素的T2DM患者。使用由3个亚领域（痛苦缓解、融洽关系和互动结果）组成的马来语医患互动满意度量表（SKIP - 11）来评估医患互动满意度。使用单项自我报告问题来测量药物依从性水平。进行了描述性、推断性和多变量分析统计的数据分析。
研究参与者的平均年龄为57.12岁（标准差：9.27）。大多数是马来人、女性、失业者，平均体重指数为27.5。大多数人报告完全依从（62.9%）。互动结果亚领域的高分与更好的依从性相关。与该亚领域高分相关的因素包括患者教育水平、口服降糖药数量和所采用的胰岛素治疗方案类型。本研究还发现，互动结果领域的高分与较低的糖化血红蛋白水平相关（p<0.05）。
医患互动满意度是实现更好的药物依从性的一个重要因素，这也会使该组患者的血糖得到更好的控制。需要确定提高该领域满意度的策略，以提高患者的依从性。
