短暂性脑缺血发作患者出院后二级预防用药情况及服药行为的混合性研究

Secondary preventive medication and medication behavior in patients with transient ischemic attack after discharge: a mixed study

摘要:

目的 探讨短暂性脑缺血发作（transient ischemic attack，TIA）患者出院后二级预防用药情况及其影响因素，并通过质性研究探讨患者服药的动机和障碍。方法 选取2016年1月至2020年12月中国人民解放军联勤保障部队第九八一医院神经内科出院的TIA患者270例，根据服药依从性分为依从性佳（116例）和依从性差（154例）两组，对比两组患者的临床资料及药物依从性，通过多因素Logistic回归分析探讨TIA患者服药依从性的影响因素。以受访者资料饱和为标准纳入10例TIA患者，采用质性研究法对患者进行半结构式深度访谈，采用Giorgi资料分析法提取和归纳主题，探讨TIA患者服药行为的内在影响因素。结果 TIA患者出院后对降压药、降糖药、降脂药、抗血栓药及抗血小板聚集药的依从性分别为69.36%、57.38%、78.95%、69.91%、68.32%。受教育程度低、卒中病程、发病次数≥2次、卒中自我效能低、无自我感知照护需求是TIA患者二级预防用药依从性差的独立危险因素（P<0.05）。从质性访谈资料中共提取出五大主题：疾病相关知识欠缺及二级预防意识淡薄、担心药物不良反应、经济负担加重、负性情绪、家庭与社会支持不足。结论 TIA患者出院后二级预防用药依从性较差，影响其服药依从性的因素主要包括患者自身因素、药物种类、医疗体系的支持、社会及家庭的支持等。受教育程度、病程、卒中自我效能及自我感知照护需求等因素在TIA患者二级预防用药中起到重要作用。 [国际神经病学神经外科学杂志, 2023, 50(2): 12-17]

Abstract:

Objective To investigate the secondary preventive medication and its influencing factors in patients with transient ischemic attack （TIA） at discharge， as well as the motivation and obstacles of medication through qualitative research.Methods A total of 270 TIA patients who were discharged from the Department of Neurology， 981 Hospital of Chinese People's Liberation Army Joint Logistics Support Force， from January 2016 to December 2020 were selected. According to medication compliance， they were divided into a good compliance group with 116 patients and a poor compliance group with 154 patients. The two groups were compared in terms of clinical data and medication compliance， and the multivariate logistic regression analysis was used to investigate the influencing factors for medication compliance in the patients with TIA. A total of 10 patients with TIA were included with the data saturation of respondents as the standard； the qualitative research method was used to conduct semi-structured in-depth interviews with patients， and the Giorgi data analysis method was used to extract and summarize related topics to investigate the internal influencing factors for the medication behavior of patients with TIA.Results The patients with TIA had a compliance rate of 69.36%， 57.38%， 78.95%， 69.91%， and 68.32% respectively， with antihypertensive drugs， hypoglycemic drugs， lipid-lowering drugs， antithrombotic drugs， and antiplatelet aggregation drugs after discharge. Low educational level， course of stroke， onset times ≥2， low stroke self-efficacy， and no self-perceived care needs were independent risk factors for poor compliance with secondary preventive medication in the patients with TIA （P<0.05）. Five themes were extracted from the qualitative interview data， i.e.， lack of disease-related knowledge and weak awareness of secondary prevention， fear of adverse drug reactions， increased economic burden， negative emotions， and insufficient family and social support.Conclusions Patients with TIA have poor compliance with secondary preventive medication after discharge， and personal factors， type of drug， support from the medical system， and social and family support are the main influencing factors for their medication compliance. Educational level， course of disease， stroke self-efficacy， and self-perceived care needs play an important role in the secondary preventive medication of TIA patients. ［Journal of International Neurology and Neurosurgery, 2023, 50(2): 12-17］