進階搜尋


 
系統識別號 U0026-0812200911135546
論文名稱(中文) 冠心症老年患者服藥遵從行為及其相關因素之探討
論文名稱(英文) An Exploration of the Medication Adherence Behaviors and Associated Factors in Elderly Patients with Coronary Heart Disease
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 92
學期 2
出版年 93
研究生(中文) 馬先芝
研究生(英文) Hsien-Jy Ma
電子信箱 mahsienjy@yahoo.com.tw
學號 t2690402
學位類別 碩士
語文別 中文
論文頁數 97頁
口試委員 指導教授-陳清惠
口試委員-盧豐華
口試委員-顏妙芬
中文關鍵字 冠心症  老年患者  服藥遵從行為 
英文關鍵字 elderly  medication adherence behaviors  coronary heart disease 
學科別分類
中文摘要   心血管疾病為台灣老年群體最常見的慢性疾病,這類慢性病的控制,必須仰賴終生規則性的服藥。然而高達60%的老年患者未遵從醫囑服藥,不但影響疾病控制,傷害老年患者健康,更造成極高的醫療負擔及資源浪費。由於國內外缺乏對於冠心症老年患者服藥遵從行為的探討,因此本研究旨在了解罹患冠心症老年患者服藥遵從行為及其相關影響因素。
  本研究採橫斷式研究法,以南部某醫學中心心血管內科門診冠心症病患為對象,以立意取樣方式,訪談241位罹患冠心症一年以上且需長期服藥之65歲以上之老年患者。本研究依據陳(2001)運用茁根理論所發展出之「老年慢性病患服藥行為模式」為架構,分析冠心症老年患者之服藥遵從行為與人口學變項、感受藥效、感受醫療夥伴關係、感受醫療現實感、以及他人影響因素間的關係。研究結果發現冠心症老年患者在服藥遵從行為一星期中有5至6天以上都會遵醫囑服藥,冠心症老年患者之人口學特徵在服藥遵從行為之間沒有差異,服藥遵從行為與感受藥效、感受醫療現實感及他人影響因素有顯著相關;經逐步迴歸分析,他人影響因素及感受藥效二項因素為服藥遵從行為之預測變項,可解釋17﹪的總變異量。本研究結果可提供臨床人員作為提昇冠心症老年患者服藥遵從行為之參考。


英文摘要   Coronary heart disease is the most common chronic disease among elderly. Life long treatment is necessary for these patients to control the progress of the disease. However, many reports suggested that 60% of the elderly patients failed to take their medication as prescribed. Instead, the patients may pay multiple visits to doctors. Sometimes, they may even need hospitalization. It not only affects the well-being of the patients, but also contributes to large waste of medical expenditure. Therefore, the purpose of this study is to explore the prescription adherence behaviors of coronary heart disease elderly patients and its related factors.
  Cross-sectional correlation design was used. Purposive sampling and face-to-face interview were conducted to recruit 241 patients over 65 years old from OPD with coronary heart diseases who received over one year prescribed medication in one of the medical centers at southern Taiwan. The conceptual framework of this study was based on Chen’s (2001) Drugs Behavioral Model of The Chronic Illness Elderly Patients. The relationship between the prescription adherence behaviors and perceived effects, perceived partnership, perceived reality, and interpersonal influence was explored.
  The results showed that the average score of prescription adherence behavior is 4.77, which indicates that the patients would follow physician’s prescription at least 5 to 6 days per week. The medication adherence behaviors were significantly correlated with perceived effects, perceived reality, and interpersonal influence (p < .05). Based on the analysis of stepwise multiple regression, perceived effects and interpersonal influence explained 17% of total variance of prescription adherence behaviors. The findings of this study may assist health professionals to provide more effective strategies to improve the medication quality of the elderly patients.


論文目次 中文摘要 I
英文摘要 III
致 謝 V
圖表目錄 IX

第一章 緒論 1
第一節 研究重要性與動機 1
第二節 研究目的 4
第二章 文獻查證 5
第一節 心血管疾病老年患者的不遵從服藥行為 5
第二節 影響老年患者服藥行為因素 9
人口學特徵 9
身體功能 13
認知程度 13
心理因素 14
社會支持相關因素 16
醫療措施因素 18
第三節 老年服藥遵從行為理論 20
衛生教育診斷模式 20
健康自控理論 21
健康決策模式與健康信念模式 22
第四節 老年慢性疾病患者服藥行為模式 24
第五節 文獻總結 27
第三章 研究架構與研究假設 28
第一節 研究架構 28
第二節 研究假設 30
第三節 名詞界定 31
第四章 研究方法與研究過程 32
第一節 研究對象 32
第二節 研究工具及測量方法 33
第三節 研究工具的信效度 35
第四節 研究過程及倫理考量 37
第五節 資料分析 39
第五章 研究結果 43
第一節 人口學特徵 43
第二節 服藥遵從行為 45
第三節 感受藥效、感受醫療夥伴關係、感受醫療現實感及他人影響因素 49
第四節 服藥遵從行為相關因素分析 53
第五節 服藥遵從行為預測因素分析 57
第六章 討論 62
第一節 人口學特徵 62
第二節 服藥遵從行為 63
第三節 感受藥效、感受醫療夥伴關係、感受醫療現實感及他人影響因素 65
第四節 服藥遵從行為相關因素分析 67
第五節 服藥遵從行為之預測因素分析 71
第七章 結論與建議 72
第一節 結論 72
第二節 研究結果之應用與建議 73
第三節 研究限制及未來相關研究之建議 75
參考資料 77
中文部分 77
英文部分 80
參考文獻 中文部分
于漱(1994).基隆市居家老人自服藥物情形與影響因素研究.公共衛生,21(2),108–117。
王保進(2002).視窗版SPSS與行為科學研究(第二版).台北:心理。
行政院內政部(2003,6月30日).台閩地區現住人口數年齡分配.內政部衛生統計資訊服務網.取自http://www.moi.gov.tw/W3/stat/home.asp
行政院衛生署(2003,6月30日).台灣地區老年人口主要死亡原因.衛生統計資訊網.取自http://www.doh.gov.tw/statistic/data/死因摘要/91年/表9.xls
行政院內政部(2004,5月18日).性別統計資料.內政部衛生統計資訊服務網.取自http://www.moi.gov.tw/W3/stat/home.asp
行政院衛生署(2004,6月4日).中華民國台灣地區2002全民健保主要疾病就診率統計.衛生統計資訊網.取自http://www. doh.gov.tw/statistic/data/全民健保主要疾病就診率統計/2002/2002.htm
吳祥恩、鄭美玲、盧豐華、張智仁(1995).服藥自我報告:簡易高血壓遵醫囑性方法之評估.中華民國家庭醫學雜誌,5(2),84-91。
吳佳蓉、陳清惠、葉忍莉(2002).老年患者服藥行為影響因素探討.長庚護理雜誌,13(2).166-174。
李炳鈺(2002).醫院門診病患用藥行為之相關因素探討.未發表的碩士論文,高雄:高雄醫學大學。
周銘霆、魏正宗、黃志峰(1995).群醫中心與地區醫院高血壓病患順服性影響因素之比較研究.中華民國家庭醫學雜誌,5(1),33-40。
胡文郁、戴玉慈、于博芮、余玉眉、曾春典(1999).老年高血壓患者服藥遵從行為及其影響因素之研究.慈濟醫學,11,(3),227-235。
徐亞瑛(2000).茁根理論.於陳月枝總校閱.質性護理研究法(pp.155-199).台北:護望。
黃麗卿、賴和鴻、李龍騰、鍾嫈嫈(1995).社區高血壓病患服藥之遵從性及衛生教育成果-以台北縣平溪鄉、石碇鄉、深坑鄉為例.中華民國家庭醫學雜誌,5,147-157。
曾春典、吳雨圭、許成仁(1992).老年病之臨床研究1208例住院老年病人之病況分析.慈濟醫學,4,154-159。
張明正(1995).台灣地區老人的社會支持型態與社會支持者的特質.台灣地區老人健康與生活研究論文集(第一輯),4-1-4-24。
陳清惠(2001).心臟血管門診病患服藥行為的探討.行政院國家科學委員會專題研究計劃成果報告.NSC89-2314-B006-220。
彭莉琴、鄭惠美(2001).某醫學中心中風高血壓病人遵醫囑服藥行為階段及相關因素之探討.衛生教育學報,15,81-97。
劉淑娟、李勤川、蘇秀娟、呂佩真(1996).台灣老年婦女的健康觀念.護理研究,4(4),387-396。
劉淑娟(1998).台灣社區老人的健康觀念與健康行為.護理雜誌,45,(6),22-28。
劉淑娟(1999).罹患慢性病老人服藥遵從行為及其相關因素之探討.護理研究,7(6),581-592。
盧豐華(1995).台南市老年人經處方及非經醫師處方用藥之追蹤調查.國科會專題研究計劃成果報告.NSC87-2314-B006-108。
謝美娥、劉淑娟(1996).失能老人社區照顧需求調查.老人教育,8,50-60。

英文部分
Atkin, P. A., Finnegan, T. P., Ogle, S. J., & Shefield, G. M. (1994). Functional ability of patient to manage medication packaging: A survey of geriatric in patients. Age-Aging, 23(2), 113-116.
Balkrishnan, R. (1998). Predictors medication adherence in the elderly. Clinical Therapeutics, 20(4), 764-771.
Berg, J. S., Dischler, J., Wagner, D. J., Raia, J. J., Palmer-Shevin, N. (1993). Medication compliance: A healthcare problem. The Annals Pharmacotherapy, 27, S2-S16.
Blenkiron, P. (1996). The elderly and their medication: Understanding and compliance in a family practice. Postgraduate Medical Journal, 72(853), 671-676.
Botelho, R. J., & Dudrak, R. (1992). Home assessment of adherence to long-term medication in the elderly. The Journal of Family Practice, 35(1), 61-65.
Butler, J., Arbogast, P. G., BeLue, R., Daugherty, J., Jain, M. K., Ray, W. A., & Griffin, M. R. (2002). Outpatient adherence to beta-blocker therapy after acute myocardial infarction. Journal of American College of Cardiology, 40(9), 1589-1595.
Charles, H., Good, C. B., Hanusa, B. H., Chang, C. C., & Whittle, J. (2003). Racial differences in adherence to cardiac medications. Journal of National Medicine Association, 95 (1), 17-27.
Chen, Y. M. (1999). Relationships among health locus of control, self-efficacy, and self-care of the elderly with hypertension. Journal of Nursing Research, 7(6), 504-517.
Chiou, C. J., & Chiru, F. J. (1995). An exploration of drugs used in the aged. Kaohsiung Journal of Medical Science, 12, 423-433.
Col, N., Fanale, J. E., & Kronholm, P. (1990). The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Archives of Internal Medicine, 150(4), 841-845.
Cohen, I., Rogers, P., Burke, V., & Beilin, L. J. (1998). Predictors of medication use, compliance and symptoms of hypotension in a community-based sample of elderly men and women. Journal of Clinical Pharmacy and Therapeutics, 23, 423-432.
Conn, V., Taylor, S., & Miller, R. (1994). Cognitive impairment and medication regimens in an elderly population. Journal of Advanced Nursing, 21(5), 935-943.
Dunbar-Jacob, J., Bobacbick, P., Mortimer, M. K., Serelika, S. M., & Foley, S. M. (2003). Medication adherence in persons with cardiovascular disease. Journal of Cardiovascular Nursing, 18(3). 209-218.
Ennis, K. J., & Richard, R. A. (1997). Maximizing drug compliance in the elderly-Tips for staying on top of your patients’ medication use. Postgraduate Medical Journal, 102(3), 211-224.
Erhardt, L. R. (1999). The essence of effective treatment and compliance is simplicity. American Journal of Hypertation, 12, 105S- 110S.
Feenstra, J., Grobbee, D. E., Jonkman, F. A., Hoes, A. W., & Stricker, B. H (1998). Prevention of relapse in patients with congestive heart failure: The role of precipitating factors. Heart, 80, 432- 436.
Francis, C. K. (1991). Hypertension, cardiac disease, and compliance in minority patients. The American Journal of Medicine, 91(suppl 1A), 29S-36S.
Gallagher, E. J., Viscoli, C. M., & Horwitz, R. I. (1993). The relationship of treatment adherence to risk of death after myocardial infarction in women. Journal of the American Medical Association, 270(6), 742-744.
Gheorghiade, M., Benatar, D., Konstam, M. A., Stoukides C. A., & Bonow, R. O. (1997). Pharmacotherapy for systolic dysfunction: A review of randomized clinical trials. American Journal of Cardiology, 80, 14H-27.
Gielen, A. C., & McDonald, E. M. (1997). The PRECEDE- PROCEDE planning model. In Glanz, K., Lewis, F. M., & Rimer, B. K. (editors). Health Behavior and Health Education. 359-383, San Francisco: Jossey-Bass Publishers.
Gravley, E. A., & Oseasohn, C. S. (1991). Multiple drug regimens: Medication compliance among veterans 65 years and older. Research in Nursing & Health, 14, 51-58.
Hamilton, G. A. (2003). Measuring adherence in a hypertension clinical trial. European Journal of Cardiovascular Nursing, 2, 219-228.
Huang, L. H. (1996). Medication-taking behavior of the elderly. Kaohsiung of Journal Medical Science, 12, 423-433.
Ho, K. K. L., Anderson, K. M., Kannel, W. B., Grossman, W., & Levy, D. (1993). Survival after the onset of congestive heart failure in Framingham heart study subjects. Circulation, 88, 107-115.
Horwitz, R. I., Viscoli, C. M., Berkman, L., Donaldson, R. M., Horwitz, S. M., Murray, C. J., Ransohoff, D. F., & Sindelar, J. (1990). Treatment adherence and risk of death after a myocardial infarction. Lancet, 336 (8714), 542-545.
Kidd, K. E. & Altman, D. G. (2000). Adherence in social context. Controlled Clinical Trial, 21, 184S-187S.
Kiortsis, N. D., Giral, P., Bruckert, E., & Turpin, G. (2000). Factors associated with low compliance with lipid-lowering drugs in hyperlipidemic patients. Journal of Clinical Pharmacy and Therapeutics, 25, 445-451.
Klein, L. E., German, P. S., McPhee, S. J., Smith, C. R., & Levine, D. M. (1982). Aging and its relationship to health knowledge and medication compliance. Gerontologist, 22(4), 384-387.
Kolton, K. A., & Piccolo, P. (1988). Patient compliance: A challenge in practice. Nurse Practitioner, 13(12), 37-50.
Lumme-Sandt, K., Hervonen, A., & Jylhä,M (2000). Interpretative reportires of medication among the oldest-old. Social Science & Medicine, 50, 1843-1850.
McElnay, J. C., McCallion, C. R., Al-Deagi, F., & Scott, M. (1997). Self-reported medication non-compliance in the elderly. European Journal of clinical Pharmacology, 53, 171-178.
Monane, M., Bohn, R. L., Gurwitz, J. H., Glynn, R. J., & Avorn, J. (1996). Compliance with antihypertensive therapy among elderly Medicaid enrollees: The roles of age, gender, and race. American Journal of Public Health, 86(12), 1805-1808.
Murray, M. D., Birt, J. A., Manatunga, A. K., & Darnell, J. C. (1993). Medication compliance in elderly outpatients using twice-daily dosing and unit-of-use packaging. The Annals of Pharmacology, 49, 255-259.
Nikolaus, T., Kruse, W., Bach, M., Specht-Leible, N., Oster, P., & Schlief, G. (1996). Elderly patients’ problems with medication- An in-hospital and follow-up study. European Journal of Clinical Pharmacology, 49, 255-259.
Okuno, J., Yanagi, H., Tomura, S., Oka, M., Hara, S., Hirano, C., & Tsuchiya, S. (1999). Compliance and medication knowledge among elderly Japanese home-care recipients. European Journal of Clinical Pharmacology, 55(2), 145-149.
Opdycke, R. A. C., Ascione, F. J., Shimp, L. A., & Rosen, R. I. (1992). A systematic approach to educating elderly patients about their medications. Patient Education and Counseling, 19, 43-60.
Patel, R. P., & Taylor, S. D. (2002). Factors affecting medication adherence in hypertensive patients. The Annals of Pharmacotherapy, 36(1), 40-45.
Rich, M. W., Gray, D. B., Beckham, V., Wittenberg, C., & Luther, P. (1996). Effect a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. American Journal of Medicine,101(3), 270-276.
Rosenstock, I. M. (1974). Historical origins of health belief model. Health Education Monograph, 2, 328-335.
Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs, 80, 1-28.
Ryan, A. A. (1999). Medication compliance and older people: A review of the literature. International Journal of Nursing Studies, 36, 153-162.
Rybacki, J. J. (2002). Improving cardiovascular health in postmenopausal women addressing medication adherence issues. Journal of the American Pharmaceutical Association, 42(1), 63-73.
Salzman, C. (1995). Medication compliance in the elderly. Journal of Clinical Psychiatry, 56, 18-22.
Simpson, S. H., Farris, K. B., Johnson, J. A., & Tsuyuki, R. T. (2000). Using focus groups to identify barriers to drug use in patients with congestive heart failure. Pharmacotherapy, 20(7), 823-829.
Simpson, S. H., Johnson, J. A., Farris, K. B., & Tsuyuki, R. T. (2002). Development and validation of a survey to assess barrier to drug use in patients with chronic heart failure. Pharmacotherapy, 22(9), 1163-1172.
Soumerai, S. B., McLaughlin, T. J., Spiegelman, D., Hertzmark, E., Thinault, G., & Goldman, L. (1997). Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. Journal of the American Medical Association, 277, 115-121.
Sullivan, S. D., Kreling, D. H., & Hazlet, T. K. (1990). Noncompliance with medication regimens and subsequent hospitalization: A literature analysis and cost of hospitalization estimate. Journal of Research Pharmaceutics Economics, 2, 19-33.
Svensson, S., Kjellgren, K. I., Ahlner, J., Säljö, R. (2000). Reasons for adherence with antihypertensive medication. International Journal of Cardiology, 76, 157-163.
Vinson, J. M., Rich, M. W., Sperry, J. C., Shah, A. S., & McNamara, T. (1990). Early readmission of elderly patients with congestive heart failure. Journal of the American Geriatrics Society, 38, 1290-1295.
Walker, M. K. & Foreman, M. D. (1999). Medication safety: A protocol for nursing action. Geriatric Nursing, 20(1), 34-39.
Woo, J., Ho, S.C., Yuen, Y. K., & Lau, J. (1995). Drug use in an elderly Chinese population: Prevalence and associated factors. Gerontology, 41, 98-108.
Wu, S. C., Liang, J., Chang, M.C., Lin, H. S, & Maloy, N. (1994). Utilization of health services among the elderly in Taiwan. Chinese Journal of Public Health, 13(2), 168–181。

論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2005-08-04起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2005-08-04起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw