通院脳卒中患者の服薬行動に関連する要因の検討―アドヒアランスの視点から

Factors Related to Adherence to a Medication Regimen in Out-patients: Being Treated for Stroke

要旨

　【目的】本研究は脳卒中の外来患者における服薬行動の特徴について，アドヒアランスの視点から検討することを目的とする．

　【方法】通院中の脳卒中患者を対象に質問紙を用い「疾病状況」，「健康状態」，「病気対処行動」(含む服　薬行動尺度)，「患者の認識」，「医療者との関係」について調査した．服薬行動には「the 4-Item Morisky Medication Adherence Scale(MMAS)」の尺度を用いた．

　【結果】研究に同意した334名は，男性65％女性35％，平均年齢は69.7±10.7歳であった．服薬行動は「低」群115名(34.4％)，「中」群133名(39.8％)，「高」群86名(25.7％)であった．ロジスティック回帰分析の結果，服薬行動との関連があったのは，服薬行動「低」群では，「肥満，運動しない，長期服薬への不安，薬は良い面より悪い面が大きいと感じる，薬の説明を受けた経験がない」の5項目，「高」群では，「薬は効果があると感じている，食事が規則的である」の2項目であった．

　【結論】服薬行動の向上には，患者の薬に対する考えを把握した上での服薬に対する正しい情報提供と日常生活や精神面を包括したアドヒアランスの視点からの支援が必要である．

Abstract

　Purpose: To study the characteristics of adherence to a medication regimen in out-patients who are being treated for stroke.

　Methods: We used a questionnaire to study the following in out-patients being treated for stroke: symptoms, health status, behavior to deal with the illness (including medication behavior), patient awareness, and the patient's relationship with health care professionals. We used the Self-Reported Medication-Taking Scale to study medication behavior.

　Results: Of the 334patients who agreed to participate in this study, 65％ were males and 35 ％ females, with an average age of 69.7±10.7. The participants were divided into three groups based on their scores for taking medication: low group (115patients,34.4％),middle group (133 patients, 39.8％), and high group (86 patients, 25.7％). The results of a logistic regression analysis found 5 influential factors for taking medication in the low group (obesity, lack of exercise, feeling that the amount of medication is too much, anxiety about taking medication for an extended period of time, and not having an explanation of the medication)and two related factors in the high group(feeling that the medication was effective and eating meals regularly). Discussion: In order to improve medication adherence, it is important to support the patient' s adherence to a medication regimen by using an overall approach that includes taking into account the patient's thoughts about medication, providing correct information and considering the patient's lifestyle and psychological state.