지역사회 노인 고혈압 환자들의 약물 순응도와 관련요인
Medication Adherence and its Predictors in Community Elderly Patients with Hypertension
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연구배경: 약물순응도는 고혈압 관리에 있어 중요한 부분이나 여전히 낮은 수준에 머무르고 있다. 약물 비순응을의도적 및 비의도적 비순응으로 구분하고 이에 따라 약물복용을 관리하는 것은 타당한 방법이지만 국내에서 이에 대한 연구가 많이 진행되지는 않고 있다. 이번 연구는 지역사회에 거주하는 고혈압 환자를 대상으로 약물 순응률과 이에 영향을 미치는 요인, 특히 의도적 약물 비순응과 비의도적 약물 비순응군을 구분하여 관련요인을 밝혀 보고자하였다. 방법: 연구 대상자는 2012년 경남 서부지역 10개 시군의지역사회건강조사 대상자 중 고혈압 치료를 받고 있는 1,988 명이며, 현재 복용하고 있는 고혈압 약물 순응도와 관련요인에 대해 분석하였다. 통계분석은 명목척도는 카이제곱 검정을, 연속변수는 ANOVA 검정을 실시하였다. 약물 순응군을 기준으로 비의도적 비순응군, 의도적 비순응군에 영향을 미치는 요인을 분석하기 위해 다항 회귀분석을 이용하였다. 결과: 연구 결과 약물 순응군이 49.8%, 비의도적 비순응군이 26.1%, 의도적 비순응군이 24.2%였다. 비의도적 약물비순응군에 영향을 미치는 요인은 우울감과 관절염 진단경험이었으나, 의도적 약물 비순응군에는 심뇌혈관질환 진단경험, 고혈압 관리에 대한 자기효능감, 약물에 대한 신념(필요성과 염려)이 영향을 미쳤다. 결론: 지역사회에 거주하고 있는 고혈압 환자들의 혈압관리를 위하여 약물 순응도 향상이 필요하며, 기존 연구에서 알려진 우울감, 자기효능감에 대해서도 관리가 필요하나, 무엇보다 의도적인 약물 비순응에 영향을 미치는 약물에 대한 믿음을 고려하는 것이 필요하다.
Abstract
Background: Medication adherence is important for hypertension management but still stay low level. It is reasonable method to classify medication nonadherence into intentional nonadherence and unintentional nonadherence and manage it according to this categories. This study aimed to explore medication adherence and its predictors in community patients with hypertension, especially dividing into intentional nonadherence and unintentional nonadherence. Methods: Study subjects included 1,988 patients who were prescribed hypertension drugs among 2012 community health survey subjects of 10 cities in Gyeongsangnamdo and we analyzed medication adherence with hypertension and its predictors. We conducted chi-square test for nominal variable and ANOVA test for continuous variable and use multinominal regression to analyze independent predictors of intentional nonadherence and unintentional nonadherence in contrast to medication adherence. Results: Of the 1,988 patients, 49.7% were adherent, 26.1% were unintentionally nonadherent and 24.2% intentionally nonadherent. Independent predictors of unintentional nonadherence were depressive symptoms (odds ratio [OR]=1.696, P=0.047) and arthritis (OR=1.319, P=0.030) and independent predictors of intentional nonadherence were cardiocerebrovascular disease (OR=1.464, P=0.044), self-efficacy (OR=0.984, P=0.007), beliefs about medications questionnaire (necessity [OR=0.834, P<0.001] and concern [OR=1.236, P<0.001]). Conclusions: In order to manage hypertension in community, improvement in medication adherence is needed. Depressive symptom and self-efficacy need to be managed, but especially patients’beliefs about their medication need to be considered to improve intentional nonadherence.
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