社區嚴重精神病病人服藥遵從性和自我及社會功能與代謝症候群之相關性

Abstract

目的：嚴重精神疾病 (severe mental illness, SMI)盛行率大約百分之二，過去的研究發現代謝症候群(metabolic syndrome, MetS)與後續的心血管疾病可能是SMI族群高共病症比率與高死亡風險的危險因子。本研究的目的希望瞭解社區SMI病人中代謝症候群的現況，以及對於服藥遵從性、自我及社會功能的相關性，並針對許多的影響因素作分析與釐清，發現是否有服藥遵從性、自我及社會功能決定性的危險因子與SMI及MetS相關，作為研擬照護措施，提升未來治療預後之參考依據。 方法：本研究採橫斷式觀察性研究設計，受試者來源為北部地區社區康復之家（全日型復健機構）之嚴重精神疾病病人，臨床診斷符合思覺失調症(ICD-9 codes, 295s)、雙相情感障礙症 (ICD-9 codes, 296s)。病人接受研究者單獨的訪談，其中使用結構式問卷、8項次之服藥遵從性量表(8-item Morisky Medication Adherence Scale, MMAS-8)與自我及社會功能量表(Personal and Social Performance, PSP)收集資料，也進行病歷查證，瞭解過去病史、藥物劑量與種類、生活型態事件與重要的代謝症候群生理指標資料收集，但若無病歷資料則受訪者便須要接受採檢3到5cc的血液檢體送檢，所得資料以R統計軟體進行分析，以描述性統計分析研究對象基本屬性，服藥遵從性、個人與社會功能及代謝症候群參數指標，主要包括次數分配、百分比、平均值、標準差；而推論性統計分析採用卡方檢定進行自變項與依變項間關係的檢定，並且以多項式邏輯斯迴歸進行代謝症候群重要相關變項之分析。 結果：共納入151位SMI病人，發現代謝症候群整體盛行率為33.8%，男性36.3%、女性31.1%，代謝症候群參數指標比例最高的為腰圍異常，佔整體62.3%；病人及照顧者觀點顯示高達半數服藥遵從度為中度以上，SMI病人服藥遵從性和罹患代謝症候群於本研究無顯著相關性；與代謝症候群相關的單變項因子有個人糖尿病病史、有飲酒習慣、有服用內外科併用藥、未接受政府每月費用補助、未能每天按時吃早餐、偶爾或經常與人有衝突或傷害別人、個人與社會功能低於平均者等；進一步多變項邏吉斯迴歸分析後仍發現飲酒習慣、服用內外科併用藥、未能按時吃早餐、與人有衝突或傷害別人以及個人與社會功能低者具有獨立相關性，值得依此發展預防策略。 結論：社區SMI病人族群中，代謝症候群異常的現況普遍，盛行率約三分之一，雖與服藥遵從性相關性不高，但與自我及社會功能較低顯著相關，未來預防照護措施應當納入提升健康生活型態（不飲酒、規律早餐、衝動控制）與資源補助（如政府經費補助），以降低社區中SMI病人罹患代謝症候群的風險，社區照護人員除了應特別注重高危險群人口學特徵之病人外，需強化篩檢後病人對自己檢查結果的瞭解並提供具體可行的健康促進方案，以落實健康篩檢是希望提早發現影響健康的危險因子與早期健康促進活動與型態介入的目的，期能促進自我及社會功能並使醫療資源能發揮最高的運用價值。

Objective: The prevalence rates of severe mental illness (SMI) are about 2%. From the previosu studies, the metabolic syndrome (MetS) and subsequent cardiovascular diseases raise the risks of comorbidity and high mortality for patients with SMI. This research aims to understand the current conditions of metabolic syndrome in the patients with SMI in communities, and their correlations with medication adherence and the Personal and Social Performance (PSP). By analyzing the risks and affecting factors, we can understand related risk factors such as medication adherence and PSP for MetS in patients with SMI. These findings can support the planning of nursing interventions that can improve the treatment outcomes. Materials and methods: This research is a cross-sectional study designed for SMI subjects from half-way house in community (all-day rehabilitation residential centers) located in northern Taiwan. The clinical diagnosis for these subjects corresponds with schizophrenia from International Statistics Classification of Diseases and Related Health Problems (ICD-9 codes, 295s) and bipolar disorders (ICD-9 codes, 296s except 296.2-3). The patients agreed to a one-on-one interview, conducted with a structured questionnaire, an 8-item Morisky Medication Adherence Scale (MMAS-8), and a Personal and Social Performance (PSP) questionnaire. Other than understanding their lifestyles, their prescriptions and dosage, and their important metabolic syndrome data, we also require the subjects to undergo a series of medical record and history verification. If the interviewee does not hold any medical records, they are then required to draw a 3-5cc blood for testing. The results of the blood test would be analyzed in the R statistic software program to grasp the basic information of the subject, medication adherence, PSP, and MetS. The parameter index used to analyze these data includes number distribution, percentage, average value, and standard deviation; inferential statistics analysis is done with the Chi-square test, which analyzes the relations between dependent and independent variables, and uses multiple logistic regression analysis to evaluate the important MetS correlated variable. Results: This research is conducted with data collected from 151 subjects. We discovered that the prevalence rate of MetS is 33.8%, with a percentage of 36.3% for male subjects, and 31.1% for female subjects. The most prevalent index of MetS is abnormal waist circumference, which is up to 62.3% among the subjects. More than half of the subjects have medium medication adherence (according to the perspectives and reviews from the patients themselves and their caregivers); however, we have not discovered major correlation between the medication adherence of SMI patients and the risk of having MetS. SMI patients had MetS have risks on a medical history of diabetes, a drinking habit, the concurrent use of non-psychiatric drugs, an irregular habit of eating breakfast, and arguments with others. Based on the multiple logistic regression, drinking habit, concurrent use of non-psychiatric drugs, unregular breakfast eating, arguments with others and low personal and social function had independent effect on the risk of MetS among SMI patients. Conclusion: It is common for community SMI patients to develop MetS, with a one in three prevalence rate among the population. Although the correlation between MetS and the subject’s medication adherence is not prominent, we have discovered the risk of developing Mets to be more intertwined with the PSP of the subjects. Future nursing intervention should include government resources and funding, and improve and promote healthier lifestyles, such as regular breakfast consumption, impulse control improvement, and alcohol abstinence. By so doing can lower the risks of MetS for patints with SMI in communities. Other than focusing on the high-risk patient population and their demographic attributes, community caretakers should also help strengthen the patient’s understanding of their own health examination results, and provide concrete and constructive advice for health improvement. Such actions help implement the objectives of health examinations and then to early discover health risk factors, and to intervene and promote healthy lifestyles. Healthcare providers can raise the personal and social functions for SMI patients, and fully utilize the medical resources to optimal value.