维持性透析患者安全用药知信行现状调查及相关因素分析

doi:10.3969/j.issn.1674-8115.2023.01.011

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (1): 88-94.doi: 10.3969/j.issn.1674-8115.2023.01.011

维持性透析患者安全用药知信行现状调查及相关因素分析

魏珊(), 纪鸥洋, 陈志豪, 黄泽慧, 李璞, 方均燕, 刘英莉()

上海交通大学医学院附属第九人民医院肾脏内科，上海 200125

收稿日期:2022-03-15 接受日期:2022-12-20 出版日期:2023-01-28 发布日期:2023-01-28
通讯作者: 刘英莉 E-mail:18252431312@163.com;18616375719@163.com
作者简介:魏　珊（1994—），女，住院医师，硕士；电子信箱：18252431312@163.com。
基金资助:
国家自然科学基金(8217030178);上海市卫生健康委员会卫生行业临床研究专项(202140430);上海交通大学医学院附属第九人民医院临床研究计划(JYLJ2018011)

A prevalence study on knowledge, attitude, belief and practice of safe medication and analysis of related factors in dialysis patients

WEI Shan(), JI Ouyang, CHEN Zhihao, HUANG Zehui, LI Pu, FANG Junyan, LIU Yingli()

Department of Nephrology, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China

Received:2022-03-15 Accepted:2022-12-20 Online:2023-01-28 Published:2023-01-28
Contact: LIU Yingli E-mail:18252431312@163.com;18616375719@163.com
Supported by:
National Natural Science Foundation of China(8217030178);Special Subject of Clinical Research of Shanghai Municipal Health Commission(202140430);Clinical Research Program of Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ2018011)

摘要/Abstract

摘要：

目的·调查维持性透析患者药物治疗管理过程中安全用药知识、信念、行为（知信行；knowledge， attitude， belief and practice，KAP）现状并分析其相关因素。方法·该研究为横断面研究，选取2019年3月至2021年3月上海交通大学医学院附属第九人民医院肾脏内科的维持性透析患者，使用经过信度、效度验证的慢性肾脏病患者安全用药KAP量表评价其用药安全情况，同时调查其人口学特征、用药清单和临床特征，根据Strand分类系统评估药物相关问题（medication-related problem，MRP）的发生情况。采用单因素分析及多重线性回归分析探索透析患者安全用药KAP水平的相关因素。结果·共纳入187例维持性透析患者，其中103例维持性血液透析患者，84例持续非卧床腹膜透析患者，平均年龄（60.19±12.80）岁，平均透析龄为（44.31±36.90）个月，平均共病（6.37±2.17）种，平均用药（7.48±2.66）种。用药安全KAP量表总分为（77.68±18.53）分，其中安全用药知识平均（24.96±8.92）分，安全用药信念平均（17.19±3.18）分，安全用药行为平均（35.40±8.18）分。单因素分析结果显示：维持性透析患者的安全用药KAP得分在不同透析方式、文化程度、经济水平及是否并发肾性贫血上差异存在统计学意义（均P<0.05），且患者的共病数越多、使用的钙磷代谢药物越多、发生的MRP越多，其安全用药KAP量表得分越低（均P<0.05）。多元线性回归显示：持续非卧床腹膜透析（β=8.391，95%CI 3.436~13.347，P=0.001）、接受过高等教育（β=9.159，95%CI 0.978~17.339，P=0.028）、家庭人均月收入>6 000元（β=8.309，95%CI 1.891~14.727，P=0.011）及共病数更少（β=-1.582，95%CI -2.783~-0.382，P=0.010）、发生的MRP更少（β=-2.284，95%CI -3.987~-0.581，P=0.009）的透析患者安全用药KAP量表得分更高。结论·维持性透析患者的安全用药KAP水平较低，血液透析、低文化程度、低经济水平、高共病数及高MRP数是透析患者安全用药KAP低水平的危险因素。

关键词: 血液透析, 腹膜透析, 安全用药, 知识-信念-行为（知信行）, 药物安全管理, 健康教育

Abstract:

Objective ·To survey the status quo of knowledge, attitude, belief and practice (KAP) of safe medication in the process of medication therapy management in dialysis patients, and analyze the related factors. Methods ·This study was a cross-sectional study with the maintenance dialysis patients selected from the Department of Nephrology, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from March 2019 to March 2021. The KAP scale for safe medication in patients with chronic kidney disease verified by reliability and validity tests was used to evaluate the status quo of safe medication, and their medication list and clinical characteristics were also investigated. The occurrence of medication-related problems (MRPs) was evaluated according to the Strand classification system. The related factors of KAP level of safe medication in the dialysis patients were analyzed by univariate analysis and multiple linear regression analysis. Results ·A total of 187 maintenance dialysis patients were included, including 103 patients with maintenance hemodialysis (MHD) and 84 patients with continuous ambulatory peritoneal dialysis (CAPD). The mean age of them was (60.19±12.80) years, the mean dialysis duration was (44.31±36.90) months, and the mean numbers of comorbidities and medications were 6.37±2.17 and 7.48±2.66, respectively. In the dialysis patients, the mean score of KAP scale was (77.68±18.53) points. The mean scores of knowledge, attitude, and practice of safe medication were (24.96±8.92), (17.19±3.18), and (35.40±8.18) points, respectively. The univariate analysis results showed that there were significant differences of KAP scores for safe medication in the dialysis pattern, the educational level, the economic level and the occurrence of renal anemia in the maintenance dialysis patients (all P<0.05). In addition, the more comorbidities or medications for regulating calcium and phosphorus metabolism the patients had, or the more MRPs occurred, the lower KAP scores for safe medication the patients got (all P<0.05). Multiple linear regression results showed that the dialysis patients with CAPD (β=8.391, 95%CI 3.436?13.347, P=0.001), with higher education (β=9.159, 95%CI 0.978?17.339, P=0.028), with per capita monthly household income of over 6 000 yuan (β=8.309, 95%CI 1.891?14.727, P=0.011), with less comorbidities (β=-1.582, 95%CI -2.783?-0.382, P=0.010), and with less MRPs (β=-2.284, 95%CI -3.987?-0.581, P=0.009) had higher KAP scores. Conclusion ·The KAP level of safe medication in the patients with maintenance dialysis is low. The hemodialysis, low educational level, low economic level, high number of comorbidities, and high number of MRPs are risk factors for low level of KAP of safe medication in dialysis patients.

Key words: hemodialysis, peritoneal dialysis, safe medication, knowledge, attitude, belief and practice (KAP), medication safety management, health education

中图分类号:

R692.5

魏珊, 纪鸥洋, 陈志豪, 黄泽慧, 李璞, 方均燕, 刘英莉. 维持性透析患者安全用药知信行现状调查及相关因素分析[J]. 上海交通大学学报（医学版）, 2023, 43(1): 88-94.

WEI Shan, JI Ouyang, CHEN Zhihao, HUANG Zehui, LI Pu, FANG Junyan, LIU Yingli. A prevalence study on knowledge, attitude, belief and practice of safe medication and analysis of related factors in dialysis patients[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(1): 88-94.

图/表 5

参考文献 21

1	WONG B, RAVANI P, OLIVER M J, et al. Comparison of patient survival between hemodialysis and peritoneal dialysis among patients eligible for both modalities[J]. Am J Kidney Dis, 2018, 71(3): 344-351.
2	LEVIN A, STEVENS P E. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward[J]. Kidney Int, 2014, 85(1): 49-61.
3	HAYWARD S, HOLE B, DENHOLM R, et al. International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study[J]. Nephrol Dial Transplant, 2021, 36(3): 503-511.
4	ROUX-MARSON C, BARANSKI J B, FAFIN C, et al. Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease[J]. BMC Geriatr, 2020, 20(1): 87.
5	ADVINHA A M, DE OLIVEIRA-MARTINS S, MATEUS V, et al. Medication regimen complexity in institutionalized elderly people in an aging society[J]. Int J Clin Pharm, 2014, 36(4): 750-756.
6	SHQEIRAT M D, HIJAZI B M, ALMOMANI B A. Treatment related problems in Jordanian hemodialysis patients[J]. Int J Clin Pharm, 2021, 43(5): 1352-1359.
7	OKPECHI I G, TINWALA M M, MUNEER S, et al. Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis[J]. Syst Rev, 2021, 10(1): 198.
8	CARDONE K E, PARKER W M. Medication management in dialysis: barriers and strategies[J]. Semin Dial, 2020, 33(6): 449-456.
9	GARCÍA-LLANA H, REMOR E, SELGAS R. Adherence to treatment, emotional state and quality of life in patients with end-stage renal disease undergoing dialysis[J]. Psicothema, 2013, 25(1): 79-86.
10	HU X L, ZHANG Y, LIN S, et al. Dietary knowledge, attitude and practice (KAP) among the family members of patients with type 2 diabetes mellitus (T2DM) and its influence on the KAP of T2DM patients[J]. Diabetes Metab Syndr Obes Targets Ther, 2021, 14: 205-213.
11	林彦君, 孟光兴. 老年人安全用药知信行现状及影响因素研究[J]. 临床医药文献杂志(电子版), 2018, 5(28): 13-15.
	LIN Y J, MENG G X. Current status of elderly about knowledge attitude practice on safe medication and the influencing factors of KAP[J]. Journal of Clinical Medical Literature (Electronic Edition), 2018, 5(28): 13-15.
12	王雷. 住院患者用药行为风险知信行调查分析[J]. 中国现代应用药学, 2019, 36(12): 1574-1577.
	WANG L. Investigation and analysis of knowledge, attitude and practice about safe use of drug on hospitalized patients[J]. Chinese Journal of Modern Applied Pharmacy, 2019, 36(12): 1574-1577.
13	魏珊, 纪鸥洋, 陈志豪, 等. 慢性肾脏病患者安全用药知信行量表的编制及信度、效度分析[J]. 上海交通大学学报(医学版), 2022, 42(12): 1729-1738.
	WEI S, JI O Y, CHEN Z H, et al. Development and validation of a knowledge, attitude, belief and practice scale for safe medication in patients with chronic kidney disease[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(12): 1729-1738.
14	武松. SPSS实战与统计思维[M]. 北京: 清华大学出版社, 2019.
	WU S. SPSS and statistical thinking[M]. Beijing: Tsinghua University Press, 2019.
15	曾晨欣, 王皓, 吴秋惠, 等. 药学服务中药物相关问题的研究进展[J]. 中国药房, 2018, 29(16): 2291-2295.
	ZENG C X, WANG H, WU Q H, et al. Progress in drug-related problem in pharmaceutical care[J]. China Pharmacy, 2018, 29(16): 2291-2295.
16	胡跃华, 于石成, 亓晓, 等. 多重线性回归模型及其应用[J]. 中华预防医学杂志, 2019, 53(6): 653-656.
	HU Y H, YU S C, QI X, et al. An overview of multiple linear regression model and its application[J]. Chinese Journal of Preventive Medicine, 2019, 53(6): 653-656.
17	胡丽萍, 但淑杰, 盖红梅, 等. 上海某社区老年慢性病共病患者多重用药分析及对生命质量的影响[J]. 药物流行病学杂志, 2020, 29(1): 30-34.
	HU L P, DAN S J, GAI H M, et al. Analysis of multiple drug use and its impact on quality of life of elderly chronic disease comorbidity patients in a community of Shanghai[J]. Chinese Journal of Pharmacoepidemiology, 2020, 29 (1): 30-34.
18	MURALI K M, MULLAN J, ROODENRYS S, et al. Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: a systematic review and meta-analysis of randomized intervention trials[J]. PLoS One, 2019, 14(1): e0211479.
19	MANLEY H J, CANNELLA C A, BAILIE G R, et al. Medication-related problems in ambulatory hemodialysis patients: a pooled analysis[J]. Am J Kidney Dis, 2005, 46(4): 669-680.
20	GHIMIRE S, CASTELINO R L, JOSE M D, et al. Medication adherence perspectives in haemodialysis patients: a qualitative study[J]. BMC Nephrol, 2017, 18(1): 167.
21	陈建华, 魏超, 邓玲. 医院-社区-家庭模式的多层面健康教育干预对老年慢性共病人群安全合理用药知信行影响的研究[J]. 中国医院药学杂志, 2020, 40(4): 452-455.
	CHEN J H, WEI C, DENG L. Study on the influence of multi-faceted health education intervention in hospital-community-family model on the knowledge-attitude-practice of safe and rational drug use in elderly chronic co-patients[J]. Chinese Journal of Hospital Pharmacy, 2020, 40(4): 452-455.

Indicator	n （%）	Score/ point	t/F value	P value
Age/year			-0.336	0.737
18‒59	83 （44.39）	77.17±17.97
≥60	104 （55.61）	78.09±19.04
Gender			-0.785	0.433
Male	120 （64.17）	76.88±18.27
Female	67 （35.83）	79.10±19.04
Marital status			-0.920	0.359
Unmarried/divorced/widowed	26 （13.90）	74.58±16.97
Married	161 （86.10）	78.18±18.77
Residence status			0.792	0.430
Living with partner	138 （73.80）	78.32±18.89
Living with kids or parents	49 （26.20）	75.88±17.54
Education level			4.446	0.013
Primary education	29 （15.51）	72.88±25.05
Secondary education	118 （63.10）	76.41±16.99
Higher education	40 （21.39）	84.90±15.67
Per capita monthly family income			10.899	0.000
<3 000 yuan	42 （22.46）	73.74±17.84
3 000‒6 000 yuan	78 （41.71）	72.90±17.80
>6 000 yuan	67 （35.83）	85.72±17.25
Insurance			-2.030	0.056
Social medical insurance	174（93.05）	76.90±18.29
Others	13（6.95）	87.15±19.30

Indicator	n （%）	Score/ point	t/F value	P value
Age/year			-0.336	0.737
18‒59	83 （44.39）	77.17±17.97
≥60	104 （55.61）	78.09±19.04
Gender			-0.785	0.433
Male	120 （64.17）	76.88±18.27
Female	67 （35.83）	79.10±19.04
Marital status			-0.920	0.359
Unmarried/divorced/widowed	26 （13.90）	74.58±16.97
Married	161 （86.10）	78.18±18.77
Residence status			0.792	0.430
Living with partner	138 （73.80）	78.32±18.89
Living with kids or parents	49 （26.20）	75.88±17.54
Education level			4.446	0.013
Primary education	29 （15.51）	72.88±25.05
Secondary education	118 （63.10）	76.41±16.99
Higher education	40 （21.39）	84.90±15.67
Per capita monthly family income			10.899	0.000
<3 000 yuan	42 （22.46）	73.74±17.84
3 000‒6 000 yuan	78 （41.71）	72.90±17.80
>6 000 yuan	67 （35.83）	85.72±17.25
Insurance			-2.030	0.056
Social medical insurance	174（93.05）	76.90±18.29
Others	13（6.95）	87.15±19.30

Indicator	n （%）	Score/ point	t/F value	P value
Dialysis pattern			-4.512	0.000
MHD	103 （55.08）	72.26±14.61
CAPD	84 （44.92）	83.32±20.64
Dialysis age/month			0.748	0.475
<12	31 （16.58）	80.42±19.32
12‒24	26 （13.90）	79.88±21.74
>24	130 （69.52）	76.58±17.68
Renal anemia			2.021	0.045
No	18 （9.63）	86.00±20.97
Yes	169 （90.37）	76.79±18.09
Renal osteodystrophy			1.440	0.152
No	24 （12.83）	82.75±22.04
Yes	163 （87.17）	76.93±17.91
Hypertension			0.017	0.987
No	23 （12.30）	77.74±17.56
Yes	164 （87.70）	77.67±18.71
Coronary heart disease			1.178	0.240
No	99 （52.94）	79.18±19.38
Yes	88 （47.06）	75.99±17.48
Diabetes mellitus			-0.726	0.469
No	134 （71.66）	77.06±17.86
Yes	53 （28.34）	79.25±20.21

Indicator	n （%）	Score/ point	t/F value	P value
Dialysis pattern			-4.512	0.000
MHD	103 （55.08）	72.26±14.61
CAPD	84 （44.92）	83.32±20.64
Dialysis age/month			0.748	0.475
<12	31 （16.58）	80.42±19.32
12‒24	26 （13.90）	79.88±21.74
>24	130 （69.52）	76.58±17.68
Renal anemia			2.021	0.045
No	18 （9.63）	86.00±20.97
Yes	169 （90.37）	76.79±18.09
Renal osteodystrophy			1.440	0.152
No	24 （12.83）	82.75±22.04
Yes	163 （87.17）	76.93±17.91
Hypertension			0.017	0.987
No	23 （12.30）	77.74±17.56
Yes	164 （87.70）	77.67±18.71
Coronary heart disease			1.178	0.240
No	99 （52.94）	79.18±19.38
Yes	88 （47.06）	75.99±17.48
Diabetes mellitus			-0.726	0.469
No	134 （71.66）	77.06±17.86
Yes	53 （28.34）	79.25±20.21

Variable	Value/n	Partial regression coefficient	Standardized regression coefficient	t value	P value
Number of comorbidities	6.37±2.17	-2.378	-2.278	-3.939	0.000
Number of medications	7.48±2.66	0.233	0.033	0.454	0.650
Number of oral tablets	17.30±9.37	0.102	0.052	0.703	0.483
Number of medications for regulating calcium and phosphorus metabolism	1.94±1.23	-2.227	-0.148	-2.040	0.043
Number of anemic medications	1.04±0.65	0.117	0.004	0.055	0.956
Number of MRPs	3.10±1.49	-4.011	-0.323	-4.636	0.000

维持性透析患者安全用药知信行现状调查及相关因素分析

A prevalence study on knowledge, attitude, belief and practice of safe medication and analysis of related factors in dialysis patients

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 21

相关文章 15

编辑推荐

Metrics

Variable	Assignment
Dialysis pattern	MHD=0； CAPD=1
Education level	Primary education=0，0，0； secondary education=0，1，0； higher education=0，0，1
Economic level	Per capita monthly family income <3 000 yuan=0，0，0； 3 000‒6 000 yuan=0，1，0；>6 000 yuan=0，0，1
Number of comorbidities	Actual value
Renal anemia	No=0； Yes=1
Number of medications for regulating calcium and phosphorus metabolism	Actual value
Number of MRPs	Actual value

Variable	Partial regression coefficient （β）	95%CI		Standardized regression coefficient （β′）	t value	P value
Variable	Partial regression coefficient （β）	Lower limit	Upper limit	Standardized regression coefficient （β′）	t value	P value
Dialysis pattern
CAPD	8.391	3.436	13.347	0.226	3.342	0.001
Education level
Secondary education	3.086	‒3.501	9.673	0.081	0.924	0.356
Higher education	9.159	0.978	17.339	0.203	2.209	0.028
Economic level
3 000‒6 000 yuan	-1.392	-7.503	4.719	-0.037	-0.450	0.654
>6 000 yuan	8.309	1.891	14.727	0.216	2.555	0.011
Number of comorbidities	-1.582	-2.783	-0.382	-0.185	-2.601	0.010
Renal anemia	-0.571	-8.993	7.851	-0.009	-0.134	0.894
Number of medications for regulating calcium and phosphorus metabolism	0.434	-1.697	2.566	0.029	0.402	0.688
Number of MRPs	-2.284	-3.987	-0.581	-0.184	-2.647	0.009

[1]	魏珊, 纪鸥洋, 陈志豪, 黄泽慧, 李璞, 方均燕, 刘英莉. 慢性肾脏病患者安全用药知信行量表的编制及信度、效度分析[J]. 上海交通大学学报（医学版）, 2022, 42(12): 1729-1738.
[2]	黄泽慧, 胡春, 李璞, 张春丽, 方均燕, 宋阿会, 魏珊, 纪鸥洋, 佟琰, 邓海, 刘英莉. 居家腹膜透析患者自我管理量表的编制及信度、效度分析研究[J]. 上海交通大学学报(医学版), 2021, 41(7): 942-948.
[3]	佟琰, 方均燕, 邓海, 宋阿会, 李璞, 刘英莉. 腹膜透析滤出液外泌体miR-200a在不同腹膜转运特性患者中的表达差异及其生物学功能预测[J]. 上海交通大学学报(医学版), 2021, 41(1): 42-48.
[4]	邓海1，佟琰1，Kristine SUN2，夏欣怡2，李璞1，张春丽1，胡春1，宋忠臣2，刘英莉1. 慢性牙周炎在腹膜透析患者中的发病状况及其与患者透析充分性的相关性研究[J]. 上海交通大学学报(医学版), 2020, 40(7): 943-949.
[5]	周悦玲，丁巍，艾红兰，卢建新，丁峰，胡春. 维持性血液透析的终末期肾病患者脑结构性异常及认知功能分析[J]. 上海交通大学学报(医学版), 2020, 40(7): 962-967.
[6]	朱旻霞1, 2，张伟明1, 2，倪兆慧2，蔡宏1, 2，鲁嘉越1, 2，刘上1, 2，占雅萍1, 2. 维持性血液透析患者透析期血压波动与透析相关并发症的相关性分析[J]. 上海交通大学学报（医学版）, 2020, 40(4): 484-.
[7]	叶祖扬，冷斌，欧俊，毕慧欣，潘罅，邹迪莎. 小内径贵要静脉转位动静脉内瘘在血液透析中的应用[J]. 上海交通大学学报（医学版）, 2020, 40(2): 276-.
[8]	卢维立1，张旭云1，廖悦1，陈慧文1，刘英莉2，宋忠臣1. 牙周基础治疗对腹膜透析牙周炎患者临床效果的观察[J]. 上海交通大学学报(医学版), 2020, 40(11): 1489-1494.
[9]	王丽 1, 2，章倩莹 1，林涛 1，徐天 1，黄晓敏 1，张春燕 1，徐耀文 1，吴珮 1，陈楠 1，任红 1，谢静远 1. 腹膜炎是腹膜透析患者全因死亡及心血管死亡的独立危险因素[J]. 上海交通大学学报（医学版）, 2019, 39(9): 1024-.
[10]	龙泉 1，秦纪平 2，李蓉 2，常娟 2，蒋更如 3，朱淳 2, 3. 血液透析联合血液灌流治疗维持性血透患者的效果观察[J]. 上海交通大学学报（医学版）, 2019, 39(8): 886-.
[11]	苏新玙，刘苗，俞赞喆，严豪，李振元，张贺，袁江姿，倪兆慧，方炜. 临床常用指标在腹膜透析患者容量状态评估中的价值[J]. 上海交通大学学报（医学版）, 2018, 38(8): 910-.
[12]	陈小妹 1，陈孜瑾 2，马晓波 2，张春丽 2，钱莹 2，俞海瑾 2，陈晓农 2. 维持性血液透析患者左心室肥厚进展情况和相关危险因素分析[J]. 上海交通大学学报（医学版）, 2018, 38(5): 505-.
[13]	庞慧华，章海芬，车妙琳，俞赞喆，林星辉，朱铭力，陆任华，方妮娜，倪兆慧，顾乐怡. 维持性血液透析患者容量状况的评估[J]. 上海交通大学学报（医学版）, 2018, 38(5): 524-.
[14]	付玉玲1，胡坤1，沈艳萍1，施鑫2，乔青1. 持续非卧床腹膜透析患者成纤维生长因子 -23及可溶性klotho蛋白水平与心脏瓣膜钙化的关系[J]. 上海交通大学学报（医学版）, 2018, 38(5): 541-.
[15]	刘苗，苏新玙，庞慧华，严豪，李振元，俞赞喆，张贺，袁江姿，倪兆慧，方炜. 腹膜透析患者脂肪含量对左心室肥厚的影响[J]. 上海交通大学学报（医学版）, 2018, 38(2): 167-.