慢性心力衰竭的患者源性因素对医院-家庭过渡期用药偏差的影响研究  

Influence of patient-related factors on medication discrepancy during hospital-home transition in patients with chronic heart failure

作　　者：苏子雯 王蔚云 徐冬梅[2] 刘长红[2] 周如华 杨磊[3] 顾则娟[1] SU Ziwen;WANG Weiyun;XU Dongmei;LIU Changhong;ZHOU Ruhua;YANG Lei;GU Zejuan(School of Nursing,Nanjing Medical University,Nanjing,Jiangsu,211166;Jiangsu Provincial People′s Hospital,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029;Nanjing University of Chinese Medicine,Nanjing,Jiangsu,210023)

机构地区：[1]南京医科大学护理学院,江苏南京211166 [2]江苏省人民医院/南京医科大学第一附属医院,江苏南京210029 [3]南京中医药大学,江苏南京210023

出　　处：《实用临床医药杂志》2023年第7期78-83,共6页Journal of Clinical Medicine in Practice

基　　金：江苏省医学创新团队基金资助项目(CXTDA2017019);江苏高校优势学科建设工程项目“护理学”(苏政办发[2018]87号)。

摘　　要：目的探讨慢性心力衰竭(CHF)的患者源性因素对医院-家庭过渡期(简称过渡期)用药偏差的影响。方法采用便利抽样法选取405例过渡期CHF患者作为研究对象,采用一般资料调查表、用药偏差评估工具、服药依从性量表(MMAS)、合理用药自我效能量表(SEAMS)、药物素养问卷进行电话随访调查,通过Logistic回归分析法分析患者源性因素对过渡期用药偏差的影响。结果405例患者中,270例发生过渡期用药偏差,发生率为66.67%;单因素分析显示,发生用药偏差患者的心力衰竭病程、MMAS得分、SEAMS得分、药物素养得分与未发生用药偏差患者比较,差异有统计学意义(P<0.05);二元Logistic回归分析显示,MMAS得分高、SEAMS得分高、药物素养得分高是CHF患者过渡期用药偏差的独立保护因素(OR=0.241、0.922、0.541,P<0.05),且MMAS得分与用药偏差关联强度最大。结论CHF患者MMAS得分、SEAMS得分、药物素养得分是过渡期用药偏差风险的影响因素,医护人员应在出院前对患者进行综合评估,并制订针对性干预策略,以减少过渡期用药偏差。Objective To investigate the influence of patient-related factors on hospital-home medication discrepancy in patients with chronic heart failure(CHF)during the transitional period(short for transitional period).Methods A total of 405 patients with CHF in the transitional period were randomly selected by convenient sampling method.A telephone follow-up study was conducted using questionnaires,including the general information questionnaire,Medication Discrepancy Tool,Morisky Medication Adherence Scale(MMAS),Self-efficacy for Appropriate Medication Use Scale(SEAMS),and medication literacy questionnaire.The influence of patient-related factors on transitional medication discrepancy was analyzed by Logistic regression.Results Among 405 patients,270 had transitional medication discrepancy,with an incidence of 66.67%.The univariate analysis showed that there were statistically significant differences between the group with medication discrepancy and the group without in terms of heart failure duration,MMAS score,SEAMS score,and medication literacy score(P<0.05).Binary Logistic regression analysis showed that high scores in MMAS,SEAMS and medication literacy were independent protective factors for transtional medication discrepancy in CHF patients(OR=0.241,0.922,0.541,P<0.05),and the MMAS score had the strongest association.Conclusion MMAS,SEAMS and medication literacy scores in patients with CHF are the influencing factors of medication discrepancy in the period of transition,suggesting the need for comprehensive assessment and targeted intervention strategies before discharge to reduce transitional medication discrepancy.

关 键 词：慢性心力衰竭 用药偏差 用药差异 医院-家庭过渡期 患者源性因素 

分 类 号：R541[医药卫生—心血管疾病] R473.5[医药卫生—内科学]