预测冠心病患者二级预防依从性的变化。
Prediction of Changes in Adherence to Secondary Prevention Among Patients With Coronary Artery Disease.
机构信息
Minmin Lu, MSN, RN, is Lecturer, School of Nursing, Fudan University, Shanghai, P.R. China. Marilyn Hravnak, PhD, RN, ACNP-BC, CCNS, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Jianying Ma, MD, is Associate Chief Physician, Zhongshan Hospital Affiliated to Fudan University, Shanghai, P.R. China. Ying Lin, RN, is Supervisor Nurse, Zhongshan Hospital Affiliated to Fudan University, Shanghai, P.R. China. Xian Zhang, RN, is Supervisor Nurse, Zhongshan Hospital Affiliated to Fudan University, Shanghai, P.R. China. Yunzhi Shen, RN, is Associate Chief Nurse, Huashan Hospital Affiliated to Fudan University, Shanghai, P.R. China. Haiou Xia, PhD, RN, is Professor, School of Nursing, Fudan University, Shanghai, P.R. China.
出版信息
Nurs Res. 2020 Sep/Oct;69(5):E199-E207. doi: 10.1097/NNR.0000000000000433.
BACKGROUND
Healthcare providers are concerned about adherence to provider recommendations in coronary artery disease management. Seeking patient-related factors influencing changes in adherence over time is necessary for formulating suitable intervention measures-especially among diverse populations.
OBJECTIVE
To explore whether health literacy, self-efficacy, and disease knowledge predict changes in adherence over time (between baseline and 3 months) to secondary prevention recommendations for Chinese coronary artery disease patients.
METHODS
A longitudinal study was performed for 662 patients following percutaneous coronary intervention in China. Self-reported data were collected at baseline during hospitalization and at a 3-month telephone follow-up. Variables included demographics, health literacy, self-efficacy, disease knowledge, and adherence to secondary prevention recommendations for medication taking and a heart-healthy lifestyle. Multinomial logistic regression identified predictors of adherence changes over time.
RESULTS
Patients were categorized into three groups: sustained/declined to nonadherence between baseline and 3 months, improved to adherence, and sustained adherence. The number of patients in sustained/declined to nonadherence group was small. Absence of stents predicted sustained/declined to nonadherence to medication and lifestyle over time. Health literacy was not associated with adherence changes over time. Higher self-efficacy scores were associated with lower likelihood of sustained/declined to nonadherence to a healthy lifestyle over time, whereas higher disease knowledge scores were associated with higher sustained/declined to nonadherence to medication.
CONCLUSIONS
Adherence to secondary prevention 3 months after discharge was relatively good in Chinese patients with coronary artery disease who received percutaneous coronary intervention. Absence of stents and lower self-efficacy can predict the poor adherence changes, which should be considered in formulating follow-up care.
背景
医疗保健提供者关注冠心病管理中遵医嘱的情况。寻找影响随时间变化的依从性的患者相关因素对于制定合适的干预措施是必要的，尤其是在不同人群中。
目的
探讨健康素养、自我效能和疾病知识是否能预测中国冠心病患者二级预防建议的依从性随时间（从基线到 3 个月）的变化。
方法
在中国对接受经皮冠状动脉介入治疗的 662 例患者进行了一项纵向研究。在住院期间的基线和 3 个月的电话随访时收集自我报告数据。变量包括人口统计学特征、健康素养、自我效能、疾病知识以及药物治疗和健康生活方式的二级预防建议的依从性。使用多项逻辑回归确定随时间变化的依从性预测因素。
结果
患者被分为三组：基线和 3 个月之间持续/下降至不依从、改善至依从和持续依从。持续/下降至不依从药物和生活方式的患者人数较少。没有支架预测了随时间持续/下降至不依从药物和生活方式。健康素养与随时间变化的依从性无关。较高的自我效能得分与随时间持续/下降至不依从健康生活方式的可能性较低相关，而较高的疾病知识得分与随时间持续/下降至不依从药物的可能性较高相关。
结论
在中国接受经皮冠状动脉介入治疗的冠心病患者中，出院后 3 个月的二级预防依从性相对较好。无支架和较低的自我效能可以预测较差的依从性变化，在制定随访护理时应考虑这些因素。
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