抗高血压药物依从性及相关因素：厄立特里亚阿斯马拉一家国家转诊医院患者的横断面分析
Antihypertensive Medication Adherence and Associated Factors: A Cross-Sectional Analysis of Patients Attending a National Referral Hospital in Asmara, Eritrea.
作者信息
Mebrahtu Goitom, M Moleki Mary, Okoth Achila Oliver, Seyoum Yemane, Adnoy Elias T, Ovberedjo Martin
机构信息
Division of Clinical Services, Ministry of Health, Asmara, Eritrea.
Department of Health Studies, University of South Africa (UNISA), Pretoria, South Africa.
出版信息
Patient Prefer Adherence. 2021 Nov 23;15:2619-2632. doi: 10.2147/PPA.S319987. eCollection 2021.
BACKGROUND
Recent research suggests that poor adherence to antihypertensive medication (AHM) is a major problem in the management of hypertension. This study was therefore designed to evaluate the frequency of AHM and associated risk factors in patients attending a national referral hospital in Asmara, Eritrea.
METHODS
A total of 335 respondents (females: 222 (66.3%) participated in this cross-sectional study. Adherence to Medication was evaluated using a modified version of the Medication Adherence Report Scale (MARS). Additional data were abstracted from patients' medical records and a WHO STEPwise questionnaire.
RESULTS
The mean (±SD) age of the study participants was 59.65 (±12.20) years (females: 56.82 (±9.95) vs males: 57.17 (±9.60) years, p-value=0.001). Similarly, the median (IQR) for diastolic blood pressure (DBP) and systolic blood pressure (SBP) were 85.00 mmHg (IQR: 80.00-90.00 mmHg) and 145.00 mmHg (IQR: 130.00-160.00 mmHg), respectively. Overall, 246 (73.4%) and 244 (72.8%) participants had poor knowledge and poor adherence to AHM, respectively. In the multivariate analysis, factors associated with increased odds of poor adherence to AHM included sex (females: adjusted odds ratio (aOR): 4.95; 95% CI: 1.52-16.11, p value=0.008); employment status (Ref: employed/NGO) (self-employed: aOR: 1.95; 95% CI: 0.45-8.48, p-value=0.373) (housewife: aOR: 0.13; 95% CI: 0.04-0.413, p-value=0.001) (unemployed: aOR: 1.38; 95% CI:0.32-5.98; p-value=0.670); lack of attendance of health talk at the clinic (aOR: 2.33; 95% CI: 1.17-4.63; p-value=0.016); high cost of transportation (yes: aOR: 6.87; 95% CI: 3.25-14.52; p-value<0.001); knowledge (poor: aOR: 6.23; 95% CI: 2.36-18.05, p-value<0.001) and hypertension stage (Stage 3: aOR: 5.55; 95% CI, 1.44-21.37, p-value=0.013). Low level of knowledge regarding hypertension-related complications or associated risk factors was also noted.
CONCLUSION
The high level of poor adherence to anti-hypertension medications and low level of knowledge on hypertension should raise concern. Overall, decentralization of health care services and educational support are vital intervention pathways in this population.
背景
近期研究表明，抗高血压药物（AHM）依从性差是高血压管理中的一个主要问题。因此，本研究旨在评估厄立特里亚阿斯马拉一家国家级转诊医院患者中AHM的使用频率及相关危险因素。
方法
共有335名受访者（女性：222名（66.3%））参与了这项横断面研究。使用改良版的药物依从性报告量表（MARS）评估药物依从性。从患者病历和一份世界卫生组织（WHO）逐步调查问卷中提取其他数据。
结果
研究参与者的平均（±标准差）年龄为59.65（±12.20）岁（女性：56.82（±9.95）岁，男性：57.17（±9.60）岁，p值=0.001）。同样，舒张压（DBP）和收缩压（SBP）的中位数（四分位间距）分别为85.00 mmHg（四分位间距：80.00 - 90.00 mmHg）和145.00 mmHg（四分位间距：130.00 - 160.00 mmHg）。总体而言，分别有246名（73.4%）和244名（72.8%）参与者对AHM的了解不足且依从性差。在多变量分析中，与AHM依从性差几率增加相关的因素包括性别（女性：调整后的优势比（aOR）：4.95；95%置信区间（CI）：1.52 - 16.11，p值=0.008）；就业状况（对照：受雇/非政府组织）（个体经营者：aOR：1.95；95% CI：0.45 - 8.48，p值=0.373）（家庭主妇：aOR：0.13；95% CI：0.04 - 0.413，p值=0.001）（失业者：aOR：1.38；95% CI：0.32 - 5.98；p值=0.670）；未参加诊所的健康讲座（aOR：2.33；95% CI：1.17 - 4.63；p值=0.016）；交通费用高（是：aOR：6.87；95% CI：3.25 - 14.52；p值<0.001）；知识水平（差：aOR：6.23；95% CI：2.36 - 18.05，p值<0.001）以及高血压分期（3期：aOR：5.55；95% CI，1.44 - 21.37，p值=0.013）。还注意到对高血压相关并发症或相关危险因素的了解水平较低。
结论
抗高血压药物的高不依从率和对高血压的低知晓率应引起关注。总体而言，医疗服务的分散化和教育支持是该人群至关重要的干预途径。
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