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標題: | 針對診斷為高血脂的病人,醫病共享決策與服藥順從性之間的關係 Examining the association between shared decision-making and medication adhesion |
作者: | Ying-Na Hsiao 蕭吟娜 |
指導教授: | 陳彥元(Yen-Yuan Chen) 陳彥元(Yen-Yuan Chen | chen.yenyuan@gmail.com | ), |
關鍵字: | 高血脂,醫病共享決策,服藥順從性, Hyperlipidemia,Shared decision making,medication adherence, |
出版年 : | 2022 |
學位: | 碩士 |
摘要: | 背景介紹 服藥順從性指的是,病患是否按醫師處方規定次數服用藥物,以及他們是否持續 照醫師處方服用藥物,好的服藥順從性比起新型的治療方法更能增進病人的健 康。影響服藥順從性的因素有很多面項,病人、藥物、看診醫師及一些系統性因 素等皆會影響服藥順從性。增加服藥順從性的策略也有很多,舉凡病人教育、藥 物管理及認知行為療法等等策略。近年來醫病關係變化,醫師不再像過去是主要 的單一決策者,醫病共享決策此種以病人為中心的看診模式更逐漸被提倡,而認 知行為的介入方式也漸被納入探討其和服藥順從性的關聯性。由過去的文獻回顧 可以發現,醫病共享決策對於高血壓的病人可以增加其服藥順從性,但對於糖尿 病的病人卻沒有辦法增加其服藥順從性,且主動式及共享式的醫病決策關係比起 較為被動式的醫病決策關係更能增加病人的服藥順從性。然而過去的文獻較少提 到醫病共享決策對於高血脂病人其服藥順從性是否有影響。過去的研究也顯示, 對於高血脂症或其他慢性疾病的病人而言,高服藥順從性的病人比低服藥順從性 的病人增加了 26%健康狀況的改善。因此可以知道,好的服藥順從性對於高血脂 症的病人來說可以有較好的健康狀況,也因此增加高血脂症病人的服藥順從性是 至關重要的議題。因此,本研究針對高血脂病人去探討醫病共享決策是否會影響 其服藥順從性。 研究方法與材料 本研究的受試者來自於臺大醫院金山分院門診病人。我們收集 182 例於門診具備 高血脂診斷的病人,請病人於看診結束後填答問卷,請病人填寫自覺其看診時和 醫生之間的醫病關係為何種醫病共享決策關係,共分成五個層次的醫病共享決策 關係分別對應不同的醫病共享決策模式(主動式、被動式、共享式),排除一例於 醫病共享決策題目填錯答案者,排除 29 例於宗教信仰、婚姻狀態、醫療保險、 月收入、疾病嚴重度等未填答完整有缺漏者,最終可納入分析之個案為 152 人。年齡分佈從 27 歲到 94 歲,平均年齡 64.1 歲,女性 92 位,男性 60 位。服藥順 從性的部份則是用藥物持有率來計算,藥物持有率越高表示其服藥順從性越好。 本研究以簡單及多重迴歸分析來探討藥物持有率及醫病共享決策之關係,並探討 問卷中各個變項和藥物持有率之關聯性。 結論 本研究之結果顯示,對於高血脂的病人而言,醫病共享決策並無法增加病人的服藥順從性,對於高血脂的病人來說,影響其服藥順從性的因素為月收入差異和不同的門診醫師,月收入高的病人其服藥順從性相對較差,而不同門診醫師之間即便醫病共享決策的方式類似,仍存在不同的服藥順從性差異,故不同門診醫師對病人服藥順從性的影響仍需待後續研究加以深入探討。 Introduction Medication adherence refers to whether patients take the medication as prescribed by the physician. Good medication adherence can improv the patients health more than new treatment methods. There are many factors that affect medication adherence. Patients , drugs, physicians, and some systemic factors can all affect medication adherence. There are also many strategies to increase medication adherence, such as patient education, medication management, and cognitive behavioral therapy. In recent years, the doctor-patient relationship has changed. Physicians are no longer the main decision-makers as in the past. The concept of shared decision making between doctors and patients is gradually being promoted, and this cognitive behavioral intervention had gradually been included to explore its relationship with medication adherence. From the literature review , it can be found that the policy of shared decision making can increase the medication adherence rate among patients with Hypertension, but it cannot increase the medication adherence rate among patients with Diabetes mellitus. Compared with passive shared decision making policy, active and shared decision making policy increased medication adherence rate . However, previous literatures seldom mentioned about whether the policy of shared decision making affects the medication adherence rate among patients with hyperlipidemia. Previous studies have also shown that for patients with hyperlipidemia or other chronic disease, patients with high medication adherence rate increased their health status by 26% compared with those with low medication adherence rate. Therefore, it can be known that good medication adherence can lead to better health status for patients with hyperlipidemia. It is important to increase the medication adherence rate among patients with hyperlipidemia. Therefore, our study aimed at examining the association between shared decision making policy and medication adherence among patients with hyperlipidemia. Material and Method The subjects of this study were enrolled from outpatient clinics from the Jinshan Branch of National Taiwan University Hospital. We collected 182 participants who were diagnosed with hyperlipidemia in the outpatient clinic. The patients were asked to fill in the basic questionnaires after visiting the outpatient clinic, and the patients were asked to fill in what they think about the doctor-patient relationship during this outpatient clinic. The relationship was divided into five levels according to the questionnaires. The decision making relationships correspond to three different decision making modes(active, passive and shared). One case was excluded due to wrong answer about the questionnaires of shared decision making, and 29 cases were excluded due to wrong answer or unanswered about the questions related to religion, marital status, medication insurance, monthly income, and disease severity. There were 152 cases that could be finally included in the analysis. The age of patients ranged from 27 to 94 years old, with an average age of 64.1 years, 92 females and 60 males. The medication adherence rate is calculated by the Medication Possession ratio(MPR). The higher the Medication Possession ratio(MPR) means the better the medication adherence rate. Our study use simple and multiple linear regression analysis to analyze the relationship between Medication Possession ratio(MPR) and shred decision making. Our study also analyze the relationship between each variable in the questionnaire and Medication Possession ratio(MPR). Conclusion The result of this study show that for patients with hyperlipidemia, the policy of shared decision making cannot increase the medication adherence rate. Factors that affect the medication adherence rate are differences in monthly income and different outpatient physicians. Patients with higher monthly income have poor medication adherence rate. Even if similar policy of shared decision making among different outpatients physicians, there are still differences in medication adherence rates. It still need further research about the influence of different outpatients physicians on medication adherence rate . |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/84517 |
DOI: | 10.6342/NTU202203768 |
全文授權: | 同意授權(限校園內公開) |
電子全文公開日期: | 2022-10-17 |
顯示於系所單位: | 醫學教育暨生醫倫理學科所 |
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