上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（公共卫生） • 上一篇    下一篇

电子监测与量表评估2型糖尿病患者服药依从性的研究

刘慧明1,2，李国红1，赵列宾1,2,3，董斌3，陆骆2，周莹霞2   

  1. 上海交通大学 1.公共卫生学院， 上海 200025； 2.医学院附属瑞金医院糖尿病中心， 上海 200025； 3.医学院附属上海儿童医学中心, 儿童健康管理研究所， 上海 200127
  • 出版日期:2016-06-28 发布日期:2016-07-25
  • 通讯作者: 李国红, 电子信箱: li_guohong@hotmail.com。
  • 作者简介:刘慧明（1991—）， 女， 硕士生; 电子信箱: sunny_lhm@126.com。
  • 基金资助:

    上海申康医院发展中心项目（SHDC12012301）；上海市第四轮公共卫生三年行动计划重点学科建设项目（15Gw2k0901）

Study on the medication adherence in patients with type 2 diabetes by electronic monitoring and scale assessment

LIU Hui-ming1,2， LI Guo-hong1， ZHAO Lie-bin1,2,3， DONG Bin3， LU Luo2， ZHOU Ying-xia2   

  1. 1.Public Health College， Shanghai Jiao Tong University， Shanghai 200025, China; 2.Center of Diabetes, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 3.Shanghai Childrens Medical Center, Institute of Children Health Management, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2016-06-28 Published:2016-07-25
  • Supported by:

    Shanghai Shenkang Hospital Development Center, SHDC12012301; Key Discipline Construction Project of Shanghai the Fourth Round of Public Health 3-years Action Plan, 15Gw2k0901

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摘要：

目的 利用电子监测药瓶和依从性量表评估2型糖尿病患者的服药依从性，并探讨两者的关系。方法 利用电子药瓶对373例2型糖尿病患者进行口服降糖药行为监测，采集相关人口统计学和血糖数据；采用中文修订版Morisky服药依从性量表-8个条目（MMAS-8）和服药信念特异性量表（BMQ-specific）分别对患者进行问卷评估。结果 ①电子监测患者的平均服药依从性为（80.5±24.8）%，其中64.9%（242例）患者为高服药依从性（电子监测服药率≥80%），服用3种口服降糖药物和服药3次/d的患者依从性最低。②MMAS-8量表平均得分为7.06±1.13，低（＜6分）、中（≥6分且＜8分）和高服药依从性（=8分）的患者分别占到11.8%（43人）、58.3%（218人）和29.9%（112人）；BMQ-specific问卷患者平均得分6.02±3.99，且信念维度得分明显高于顾虑维度（P=0.000）。③电子监测依从性较高的患者空腹血糖及糖化血红蛋白水平较低（P=0.038和P=0.015），问卷评估不同等级依从性分组患者的服药率（电子监测）和糖化水平之间差异无统计学意义（P=0.725）；量表评估与电子监测均为高依从性患者的血糖控制最好，糖化为（6.79±1.12）%，量表评估为高服药依从性而电子监测显示低依从性的患者的糖化血红蛋白水平最高（7.52±1.50）%。结论 服药种类、服药频率对依从性存在影响。量表评估结果高估了患者实际口服降糖药依从性。部分患者遵循医嘱合理服药和坚持服药的意识还有待加强且服药顾虑（不良反应和药物依赖等）对患者服药行为产生较大消极影响，需加强心理疏导和服药教育。实际治疗依从性较低而主观上又高估自我服药依从性的患者血糖控制较差。

关键词: 2型糖尿病, 服药依从性, 电子监测, 量表评估

Abstract:

Objective To assess the medication adherence in patients with type 2 diabetes with electronically monitored medicine bottles and the adherence scale and explore the association between results from electronic monitoring and the adherence scale. Methods The oral hypoglycemic medication in 373 patients with type 2 diabetes was monitored with electronic medicine bottles and related demographic and blood glucose data were collected. Patients were assessed with Chinese revised version of 8-item Morisky medication adherence scale (MMAS-8) and beliefs about medication questionnaire (BMQ-specific). Results ①The average medication adherence in patients monitored with electronic bottles was (80.5±24.8)%, 64.9% (242) of which had high medication adherence (medication rate≥80%). The medication adherence in patients taking 3 kinds of hypoglycemic medications or taking medications 3 times a day was the lowest. ②The average score of MMAS-8 was 7.06±1.13. Patients with low (<6), intermediate (≥6 and <8), and high (=8) medication adherence accounted for 11.8% (43), 58.3% (218), and 29.9% (112), respectively. The average score of BMQ-specific was 6.02±3.99 and the score of specific-necessity item was significantly higher compared with the specific-concerns item (P=0.000). ③The fasting blood glucose and glycosylated hemoglobin levels in patients with high medication adherence were lower (electronic monitoring, P=0.038, P=0.015, respectively). The differences in medication rate (electronic monitoring) and glycosylation level in patients with different levels of medication adherence assessed by questionnaires were not statistically significant (P=0.725). Patients with high medication adherence assessed by both scale and electronic monitoring had the best control over blood glucose with a glycosylated hemoglobin level of (6.79±1.12)%. Patients with high medication adherence assessed by scale and with low medication adherence assessed by electronic monitoring had the highest glycosylated hemoglobin level of (7.52±1.50)%. Conclusion Medication types and medication frequency affect the medication adherence. The scale assessment overestimates the actual medication adherence in patients. The consciousness of adhering to orders for rational and persistent medication in some patients still needs enhanced. Concerns of taking medication (such as adverse effects and drug dependence) greatly affect the medication behavior in patients, and psychological counseling and medication education need to be strengthened. Patients with low actual medication adherence and overestimated medication adherence have poor control over their blood glucose.

Key words: type 2 diabetes, medication adherence, electronic monitoring, scale assessment