Influencing Factors for Medication Experience and Medication Adherence in Elderly Patients with Chronic Diseases

doi:10.12114/j.issn.1007-9572.2024.0137

Chinese General Practice ›› 2025, Vol. 28 ›› Issue (11): 1309-1314.DOI: 10.12114/j.issn.1007-9572.2024.0137

• Multimorbidity Section • Previous Articles Next Articles

Influencing Factors for Medication Experience and Medication Adherence in Elderly Patients with Chronic Diseases

1. School of Management, Shandong Second Medical University, Weifang 261053, China
2. "Health Shandong" Severe Social Risk Prevention and Management Synergy Innovation Center, Weifang 261053, China
3. Collaborative Innovation Center of Social Risks Governance in Health, Shanghai 200032, China
4. China National Health Development Research Center, Beijing 100191, China

Received:2024-04-10 Revised:2024-07-10 Published:2025-04-15 Online:2025-02-06
Contact: CHEN Zhongming

老年慢性病患者用药体验对用药依从性的影响研究

1．261053　山东省潍坊市，山东第二医科大学管理学院
2．261053　山东省潍坊市，"健康山东"　重大社会风险预测与治理协同创新中心
3．200032　上海市，国民健康社会风险预警协同创新中心
4．100191　北京市，国家卫生健康委卫生发展研究中心

通讯作者: 陈钟鸣
作者简介:
作者贡献：
高敏、陈钟鸣负责文章构思与整体框架设计，实施具体研究过程；高敏、李晓娜、时永利、李子源、董平负责数据收集整理；高敏、李晓娜负责数据统计学分析，图表绘制；高敏负责论文撰写；丰志强、马东平、尹文强负责讨论建议部分修订；陈钟鸣负责修订文章整体，对文章质量进行控制与审校，监督管理。
基金资助:
国家自然科学基金面上项目(72274140); 山东省级人才工程(tsqn202312250); 山东省人文社会科学课题(2022-JCGL-02); 中国博士后科学基金面上资助项目(2023M740873)

Abstract

Abstract:

Background

With the accelerated population aging, the number of elderly patients with chronic diseases is growingly elevated. Adherence to medication regimens is pivotal for the health outcomes of chronic diseases. Existing research mainly analyzed influencing factors for medication adherence and the outcome of medication adherence by interventions. A single analysis of medication adherence from the aspect of medication experience is one-sided.

Objective

To understand the current situations of medication experience and medication adherence in elderly patients with chronic diseases, and to explore the influence of medication experience at multiple dimensions on medication adherence, thus proposing countermeasures to improve medication adherence in elderly patients with chronic diseases.

Methods

From September 2023 to December 2023, a total of 2 432 residents of three cities in Shandong Province were selected by stratified random sampling according to the economic level and social development. Elderly patients (>60 years of age) with chronic diseases and long-term medications were screened according to the inclusion and exclusion criteria. A self-designed Medication Experience Scale, consisting of 7 dimensions and 28 items was used to investigate the medication experience. A Chinese version of 4-item Medication Adherence Scale was used to investigate the medication adherence. Current status of patients' medication experience and medication adherence were described. Multiple linear regression was performed to analyze the dimensions of medication experience that greatly influenced medication adherence.

Results

A total of 2 432 questionnaires were distributed in this survey, and 2 415 were retrieved. After excluding samples with missing data on the main variables, a total of 1 544 samples were included in this study. The mean score of medication experience of elderly patients with chronic diseases was (4.31±0.39) point, with the highest score in the dimension of life influenced by medication (4.72±0.58) points, and lowest in the dimension of convenience (3.86±0.49) points. The mean score of medication adherence in elderly patients with chronic diseases was (3.48±0.62) points. A total of 698 (45.2%) patients were identified as a poor adherence. The most common cause for non-adherence was 'forgetting to take medication' (77.1%, 538/698). Medication adherence scores were significantly lower in female elderly, or elderly patients with two or more chronic diseases than those of counterparts (P<0.05). The results of multivariate linear regression showed that medication adherence was worse in female elderly patients (β=-0.056) and elderly patients with two or more chronic diseases (β=-0.053) (P<0.05). Among the dimensions of the Medication Experience Scale, the dimensions of effectiveness (β=0.083), and affordability (β=0.135) positively predicted patients' medication adherence (P<0.05) .

Conclusion

The proportion of elderly patients with poor medication adherence to chronic diseases in Shandong Province is 45.2%, among whom, female patients and elderly patients with two or more chronic diseases have a worse medication adherence. The effectiveness and affordability dimensions of the medication experience are positive predictors of medication adherence. Relevant departments should focus on continuously reducing the price of chronic disease medicines, and doctors should strengthen the pharmacy guidance service provided to female patients and elderly patients with two or more chronic diseases.

Key words: Chronic disease, Aged, Medication experience, Medication adherence, Multiple linear regression

摘要：

背景

随着老龄化程度的加剧，老年慢性病患者的规模不断扩大，用药依从性对慢性病患者的健康结局至关重要。现有研究大多分析了用药依从性的影响因素和干预措施对提升用药依从性的效果，但从用药体验角度分析对用药依从性影响的研究还不够全面。

目的

了解老年慢性病患者用药体验和用药依从性现状，探讨用药体验多个维度对用药依从性产生的影响，就提升老年慢性病患者用药依从性提出对策。

方法

2023年9—12月，采用分层随机抽样在山东省内按照经济社会发展水平抽取3个地级市共2 432位居民，再依据纳入标准筛选出60岁以上且长期服药的老年慢性病患者进行调查研究。使用课题组研制的慢性病患者用药体验量表调查患者用药体验状况，量表包含7个维度28个条目，采用中文版4条目服药依从性问卷调查患者用药依从性状况。描述患者的用药体验与用药依从性现状，采用多元线性回归分析对患者用药依从性产生重要影响的用药体验维度。

结果

本次调查共发放问卷2 432份，回收问卷2 415份，剔除问卷主要变量数据缺失的样本后，共有1 544例样本纳入本研究。老年慢性病患者用药体验均分为（4.31±0.39）分，药物的生活影响维度均分最高，为（4.72±0.58）分；方便性维度均分最低，为（3.86±0.49）分。老年慢性病患者用药依从性平均分为（3.48±0.62）分，筛查出依从性差的患者698例（45.2%），其服药不依从最主要的表现是"忘记服药"，占比77.1%（538/698）。女性、患慢性病数量2种及以上的老年慢性病患者用药依从性得分与男性、患1种慢性病患者相比较低（P<0.05）。多元线性回归分析结果显示，女性（β=-0.056）、患慢性病数量2种及以上（β=-0.053）的老年慢性病患者用药依从性较差（P<0.05），在用药体验量表的各维度中，有效性（β=0.083）、可负担性（β=0.135）两个维度对患者用药依从性具有正向预测作用（P<0.05）。

结论

山东省老年慢性病患者用药依从性差的比例为45.2%，其中女性、患慢性病数量2种及以上的老年慢性病患者用药依从性较差，有效性、可负担性两个维度对患者用药依从性具有正向预测作用。相关部门应注意持续降低慢性病药物价格，医生应当加强对女性、共病的老年慢性病患者的药事指导服务。

关键词: 慢性病, 老年人, 用药体验, 用药依从性, 多元线性回归

CLC Number:

R 36

GAO Min,LI Xiaona,SHI Yongli, et al. Influencing Factors for Medication Experience and Medication Adherence in Elderly Patients with Chronic Diseases[J]. Chinese General Practice, 2025, 28(11): 1309-1314. DOI: 10.12114/j.issn.1007-9572.2024.0137.
高敏,李晓娜,时永利等. 老年慢性病患者用药体验对用药依从性的影响研究[J]. 中国全科医学, 2025, 28(11): 1309-1314. DOI: 10.12114/j.issn.1007-9572.2024.0137.

Figures/Tables 3

References 23

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因素	例数	用药依从性得分	t（F）值	P值
性别			2.406	0.016
男	552	3.53±0.60
女	992	3.45±0.63
年龄			0.959^e	0.384
60~69岁	684	3.46±0.64
70~79岁	734	3.50±0.60
≥80岁	126	3.49±0.63
现居地			-0.368	0.713
城市	155	3.46±0.62
农村	1 389	3.48±0.62
文化程度^a			0.808^e	0.446
小学及以下	1 026	3.47±0.62
初中	368	3.50±0.62
高中及以上	149	3.52±0.59
所患慢性病数量			2.513	0.012
1种	637	3.53±0.60
2种及以上	907	3.45±0.63
婚姻状况			0.497	0.619
在婚	1 257	3.48±0.62
非在婚	287	3.50±0.60
是否独居^b			-0.896	0.371
否	1 293	3.48±0.62
是	247	3.51±0.60
是否与配偶同住^c			1.050	0.294
否	346	3.51±0.60
是	1 189	3.47±0.63
是否与子女同住^d			0.127	0.899
否	1 297	3.48±0.62
是	230	3.47±0.64

因素	例数	用药依从性得分	t（F）值	P值
性别			2.406	0.016
男	552	3.53±0.60
女	992	3.45±0.63
年龄			0.959^e	0.384
60~69岁	684	3.46±0.64
70~79岁	734	3.50±0.60
≥80岁	126	3.49±0.63
现居地			-0.368	0.713
城市	155	3.46±0.62
农村	1 389	3.48±0.62
文化程度^a			0.808^e	0.446
小学及以下	1 026	3.47±0.62
初中	368	3.50±0.62
高中及以上	149	3.52±0.59
所患慢性病数量			2.513	0.012
1种	637	3.53±0.60
2种及以上	907	3.45±0.63
婚姻状况			0.497	0.619
在婚	1 257	3.48±0.62
非在婚	287	3.50±0.60
是否独居^b			-0.896	0.371
否	1 293	3.48±0.62
是	247	3.51±0.60
是否与配偶同住^c			1.050	0.294
否	346	3.51±0.60
是	1 189	3.47±0.63
是否与子女同住^d			0.127	0.899
否	1 297	3.48±0.62
是	230	3.47±0.64

用药体验及各维度得分	用药依从性得分
用药体验及各维度得分	r值	P值
用药体验量表总得分	0.139	<0.001
有效性维度得分	0.108	<0.001
可负担性维度得分	0.161	<0.001
用药指导充分性维度得分	0.063	0.013
安全性维度得分	0.096	<0.001
药物的生活影响维度得分	0.064	0.013
方便性维度得分	-0.015	>0.05
用药指导人文性维度得分	0.010	>0.05

用药体验及各维度得分	用药依从性得分
用药体验及各维度得分	r值	P值
用药体验量表总得分	0.139	<0.001
有效性维度得分	0.108	<0.001
可负担性维度得分	0.161	<0.001
用药指导充分性维度得分	0.063	0.013
安全性维度得分	0.096	<0.001
药物的生活影响维度得分	0.064	0.013
方便性维度得分	-0.015	>0.05
用药指导人文性维度得分	0.010	>0.05

变量	B（95%CI）	SE	β	t值	P值	容差	VIF
常数项	2.956（2.693~3.219）	0.134	—	22.027	<0.001	—	—
性别	-0.073（-0.136~-0.009）	0.032	-0.056	-2.245	0.025	0.990	1.010
所患慢性病数量	-0.033（-0.063~-0.002）	0.016	-0.053	-2.093	0.036	0.965	1.037
有效性	0.084（0.034~0.135）	0.026	0.083	3.264	0.001	0.963	1.039
可负担性	0.082（0.051~0.112）	0.016	0.135	5.234	<0.001	0.938	1.066

Influencing Factors for Medication Experience and Medication Adherence in Elderly Patients with Chronic Diseases

老年慢性病患者用药体验对用药依从性的影响研究

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