류마티스관절염 대상자의 약물복용이행 영향요인
Factors Affecting Medication Adherence in Patients with Rheumatoid Arthritis
0
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
연구배경: 류마티스관절염의 약물 치료는 염증 완화를 위해 필요한 주요 치료로, 질병 초기에 적극적인 약물 치료를시작하여 처방에 따라 꾸준히 약물을 복용하는 것이 중요하다. 그러나 많은 대상자들이 약물복용이행을 잘하지 못하는것으로 보고되고 있다. 따라서 본 연구에서는 학습된 무력감과 약물에 대한 태도를 포함하여 류마티스관절염 대상자의 약물복용이행에 영향을 미치는 요인을 파악하고자 하였다. 방법: 경기도 소재 일개 대학병원 류마티스내과 외래를통원중인 류마티스관절염 환자 345명을 대상으로 구조화된설문지를 이용하여 자료수집하였다. 수집된 자료는 SPSS ver. 25 (IBM Corp.)를 이용하여 기술통계, t-test, chi-square test, 회귀분석을 이용하여 분석하였다. 결과: 연구 대상자의 65.2%가 약물복용이행 그룹으로 분류되었다. 약물복용이행 그룹이 불이행 그룹에 비해 약물에대한 태도가 긍정적이며 학습된 무력감이 낮았다. 회귀분석을 이용하여 약물복용이행 영향요인을 분석한 결과 학습된무력감이 높을수록 약물복용이행 가능성이 통계적으로 유의하게 낮았다(OR, 0.92; 95% CI, 0.86-0.98). 결론: 류마티스관절염 대상자들의 약물복용이행률을 증진하기 위해서는 수정 가능한 심리 정서적 반응인 학습된무력감을 낮추는 것이 요구된다. 이를 위해 정확한 지식 및행위를 기반으로 한 보건교육과 함께 대상자를 격려하고 동기를 부여할 수 있는 중재 개발 및 적용이 요구된다.
Abstract
Background: Adherence to medication in patients with rheumatoid arthritis has been associated with decreased disease activity and morbidity in prior reports. However, adherence in this population remains suboptimal. This study evaluated the levels of medication adherence and determined the factors thereof in patients with rheumatoid arthritis. Methods: We analyzed cross-sectional data from 345 rheumatoid arthritis outpatients at a university-affiliated hospital. The level of medication adherence was then determined. Lastly, a multivariate logistic regression analysis was used to identify the predictors significantly associated with medication adherence. Results: Approximately 65% of the subjects were categorized as medication-adherent. In univariate analysis, educational level, perceived health, attitude toward medication, and level of learned helplessness all differed significantly between the adherent and nonadherent groups. When controlling for other factors, higher levels of learned helplessness significantly lowered the likelihood of patients’ adherence to medication in our cohort. Conclusions: Given that learned helplessness is modifiable, the results of this study suggest that interventions to decrease the degree of learned helplessness should be developed and implemented in order to increase the levels of medication adherence in patients with rheumatoid arthritis and improve clinical outcomes.
참고문헌 (28)
- Peters MJ, "EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis", Ann Rheum Dis, 69(2), pp.325~331 (2010)
- 조수경, "류마티스관절염의 약물치료", 대한의사협회지, 60(2), pp.156~163 (2017), 대한의사협회[DOI]
- Katchamart W, "Rate and causes of noncompliance with disease-modifying antirheumatic drug regimens in patients with rheumatoid arthritis", Clin Rheumatol (2020)
- Li L, "Medication adherence has an impact on disease activity in rheumatoid arthritis : a systematic review and meta-analysis", Patient Prefer Adherence, 11, pp.1343~1356 (2017)
- Pascual-Ramos V, "Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients : associated factors and relationship with disease activity and with disability", Arthritis Res Ther, 11(1), pp.R26~ (2009)
- Contreras-Yáñez I, "Persistence on therapy is a major determinant of patient-, physician-and laboratory-reported outcomes in recent-onset rheumatoid arthritis patients", Clin Exp Rheumatol, 28(5), pp.748~751 (2010)
- Elliott RA, "Poor adherence to medication in adults with rheumatoid arthritis", Dis-Manage-Health-Outcomes, 16(1), pp.13~29 (2008)
- Wong PK, "Medication adherence in patients with rheumatoid arthritis : why do patients not take what we prescribe", Rheumatol Int, 36(11), pp.1535~1542 (2016)
- Berner C, "Medication adherence and coping strategies in patients with rheumatoid arthritis : a cross-sectional study", Int J Rheumatol, 2019, pp.4709645~ (2019)
- Young Sun Suh, "Medication nonadherence in Korean patients with rheumatoid arthritis: the importance of belief about medication and illness perception", The Korean Journal of Internal Medicine, 33(1), pp.203~210 (2018), 대한내과학회[DOI]
- Neame R, "Beliefs about medications : a questionnaire survey of people with rheumatoid arthritis", Rheumatology(Oxford), 44(6), pp.762~767 (2005)
- Dirik G, "Psychological distress in rheumatoid arthritis patients : an evaluation within the conservation of resources theory", Psychol Health, 25(5), pp.617~632 (2010)
- Stein MJ, "Factor structure of the arthritis helplessness index", J Rheumatol, 15(3), pp.427~432 (1988)
- Camacho EM, "Association between socioeconomic status, learned helplessness, and disease outcome in patients with inflammatory polyarthritis", Arthritis Care Res(Hoboken), 64(8), pp.1225~1232 (2012)
- Englbrecht M, "The impact of coping strategies on mental and physical well-being in patients with rheumatoid arthritis", Semin Arthritis Rheum, 41(4), pp.545~555 (2012)
- 한정원, "류마티스 관절염 환자의 무기력과 건강행위에 관한 연구", 근관절건강학회지, 15(1), pp.33~40 (2008), 대한근관절건강학회
- 부선주, "학습된 무력감이 류마티스관절염 대상자의 규칙적 운동에 미치는 영향", 근관절건강학회지, 24(2), pp.150~158 (2017), 대한근관절건강학회[DOI]
- Pincus T, "Toward a multidimensional Health Assessment Questionnaire(MDHAQ) : assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format", Arthritis Rheum, 42(10), pp.2220~2230 (1999)
- Lee SS, "Evaluating the Korean version of the multidimensional health assessment questionnaire in patients with rheumatoid arthritis", Clin Rheumatol, 25(3), pp.353~357 (2006)
- DeVellis RF, "A brief measure of helplessness in rheumatic disease : the helplessness subscale of the rheumatology attitudes index", J Rheumatol, 20(5), pp.866~869 (1993)
- Nakagawa S, "Effect of medication adherence on disease activity among Japanese patients with rheumatoid arthritis", PLoS One, 13(11), pp.e0206943~ (2018)
- 이주현, "Poor agreement between QuantiFERON-TB Gold test and tuberculin skin test results for the diagnosis of latent tuberculosis infection in rheumatoid arthritis patients and healthy controls", The Korean Journal of Internal Medicine, 29(1), pp.76~84 (2014), 대한내과학회[DOI]
- Sung YK, "Korean observational study network for arthritis(KORONA) : establishment of a prospective multicenter cohort for rheumatoid arthritis in South Korea", Semin Arthritis Rheum, 41(6), pp.745~751 (2012)
- 최요한, "주관적 건강은 실제 건강의 좋은 대리변수인가", 노인복지연구, 73(4), pp.7~28 (2018), 한국노인복지학회[DOI]
- 조영문, "혈액투석 환자의 건강정보이해능력에 따른 질병불확실성, 주관적 건강상태및 환자역할행위 이행과의 관계", 성인간호학회지, 30(4), pp.437~446 (2018), 한국성인간호학회[DOI]
- Zwikker HE, "Perceived need to take medication is associated with medication non-adherence in patients with rheumatoid arthritis", Patient Prefer Adherence, 8, pp.1635~1645 (2014)
- Covic T, "A biopsychosocial model of pain and depression in rheumatoid arthritis : a 12-month longitudinal study", Rheumatology(Oxford), 42(11), pp.1287~1294 (2003)
- Heidari P, "Rheumatologists' insight into medication adherence in patients with rheumatoid arthritis : a qualitative study", Int J Rheum Dis, 22(9), pp.1695~1705 (2019)