약물 치료가 만성질환자의 건강행태에 미치는 영향
The Impact of Pharmacological Interventions on Health-Related Behaviors in Patients with Chronic Diseases
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만성질환의 약물 치료와 더불어 다양한 건강 행태가 긍정적으로 개선·유지될 경우 만성질환 관리의 효과가 극대화될 수 있다. 그럼에도 불구하고, 만성질환을 효율적으로 관리할 수 있는 약물 치료가 환자로 하여금 건강 행위를 지속할 유인을 감소시키거나 대체하는 부정적인 효과로 나타날 가능성도 생각해볼 수 있다. 이 연구에서는 1기 한국의료패널 자료의 만성질환 및 일반의약품 이용 정보를 활용하여, 고혈압, 당뇨병, 이상지질혈증의 신규 만성질환자가 각각 약물 치료를 시작한 이후, 신체활동, 운동, 음주, 흡연 등의 건강행태의 변화가 관찰되는지 확인하고자 했다. 패널 고정효과 모형을 통해 추정한 결과, 고혈압 환자군에서 약물 치료 이후, 통계적으로 유의하게 대사당량 및 고강도·중등도 운동 참여 확률이 감소하는 것으로 나타났다. 반면, 세 질환 모두 흡연 및 음주 등 건강 위해 행위의 감소도 관찰되었다. 즉, 질환별, 건강행태별로 약물치료의 건강행태에 대한 대체효과 및 보완효과가 상이하게 나타날 수 있음을 확인했다. 주관적 건강상태를 교호항으로 추가한 분석을 통해, 약물 치료 이후 주관적 건강상태가 긍정적으로 변화되거나 현재 수준으로 유지된 고혈압 환자 집단에서 신체활동 감소가 유의하게 관찰됨을 확인했다. 만성질환 관리를 위한 약물 치료 과정에서 병행되어야 하는 건강 행태의 개선 및 유지를 위해, 만성질환의 종류 및 건강행태별로 구체적이고 세심한 정책 접근이 필요하다는 점을 시사한다.
Abstract
Enhancing and sustaining a spectrum of health behaviors in conjunction with pharmacological intervention for chronic disease is imperative to optimize the efficacy of chronic disease management. Nevertheless, the medication itself may have the opposite effect, potentially undermining the motivation of patients to enhance and maintain their health behaviors. This study analyzed data from the Korea Health Panel Study to ascertain whether patients newly diagnosed with hypertension, diabetes, and dyslipidemia altered their health behaviors, including physical activity, exercise, alcohol consumption, and smoking, following the initiation of drug treatment. The panel fixed-effect model estimates indicated that drug treatment was associated with a reduction in physical activity and the probability of engaging in vigorous to moderate exercise among individuals diagnosed with hypertension. However, a reduction in health-risk behaviors, such as smoking and alcohol consumption, was also observed for all three conditions, indicating that the substitution and complement effects of medication on health behaviors may vary across conditions and health behaviors. Further analysis revealed that the reduction in physical activity following medication was significant in the hypertension population, where self-assessed health status improved or remained unchanged after medication. These findings underscore the necessity for tailored policy approaches to enhance and sustain health behaviors after drug treatment for chronic disease management.
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