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经皮冠状动脉介入治疗后女性冠心病患者的治疗依从性。

Adherence to Treatment of Female Patients With Coronary Heart Disease After a Percutaneous Coronary Intervention.

机构信息

Outi Kähkönen, PhD, RN Doctor, University Teacher and Post Doctoral Researcher, Research Unit of Nursing Science and Health Management, University of Oulu, Finland. Terhi Saaranen, PhD, RN, PHN Docent, Department of Nursing Science, University of Eastern Finland. Kuopio, Finland. Päivi Kankkunen, PhD, RN Docent, Department of Nursing Science, University of Eastern Finland. Kuopio, Finland. Heikki Miettinen, PhD, MD Docent, Kuopio University Hospital, Finland. Helvi Kyngäs, PhD, RN Professor, Research Unit of Nursing Science and Health Management, University of Oulu, Finland.

出版信息

J Cardiovasc Nurs. 2019 Sep/Oct;34(5):410-417. doi: 10.1097/JCN.0000000000000592.

Abstract

BACKGROUND

Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients.

OBJECTIVE

The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention.

METHODS

A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model.

RESULTS

Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it.

CONCLUSIONS

Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.

摘要

背景

坚持治疗对于预防冠心病(CHD)的进展至关重要,冠心病是女性中最常见的死亡原因。女性冠心病有其特殊的特点:传统的风险因素对女性的危害比男性更大,危险因素的积累很常见,而且女性还有非传统的风险因素,如妊娠糖尿病和子痫前期。此外,女性患者经皮冠状动脉介入治疗后的预后较差,死亡率和并发症发生率更高。

目的

本研究旨在检验经皮冠状动脉介入治疗后女性 CHD 患者治疗依从性的模型。

方法

2013 年进行了一项横断面、描述性和解释性调查,共纳入 416 名 CHD 患者,其中 102 名女性患者纳入本亚研究。采用自我报告的工具评估女性患者对治疗的依从性。使用描述性统计和结构方程模型进行数据分析。

结果

动机是女性患者感知治疗依从性的最强预测因素。信息支持、医生支持、感知健康和身体活动通过动机与感知治疗依从性间接但显著相关。此外,身体活动与感知健康呈正相关,而焦虑和抑郁则与感知健康呈负相关。

结论

二级预防计划和患者教育必须考虑到个体或独特的差异。重要的是要关注那些已知有助于提高动机的问题,而不仅仅是依靠教育来提高依从性。

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