Abstract: Background　Medication compliance is a key determinant of whether a drug treatment could be achieve good therapeutic effects in hypertensive patients. So it is essential to understand medication compliance and associated factors to improve blood pressure control rate in such patients. Objective　To analyze the medication compliance and associated factor of pathways of action in elderly hypertensive patients in the community，providing a reference for medical workers to formulate measures to improve medication compliance in such patients. Methods　From July to August 2017，by use of typical sampling，1 157 elderly hypertensive patients were selected from 3 urban and 2 rural communities（of the Xinjiang Production and Construction Corps） in a city，and received a face-to-face questionnaire survey regarding demographics and medication compliance. Path analysis using Anderson's model of health service utilization was performed to analyze the interrelationship among influencing factors of medication compliance. The survey achieved a response rate of 94.20%（1 090/1 157）. Results　The respondents included 396 men（36.33%） and 694 women（63.67%），and had a mean age of（73.5±7.3）years，and a good medication compliance of 63.21%（689/1 090）. There were statistically significant differences in medication compliance among hypertension patients with different propensity（place of residence），enabling resources（medical insurance reimbursement policies for outpatient cost for special chronic diseases，life stresses，monthly antihypertensive drug cost），demand factors（self-assessed health statu，sleep disorders），and health behavior（drinking）（P<0.05）. There were significant differences in the number of chronic diseases and the average duration of hypertension between the patients with good medication compliance and those with poor medication compliance（P<0.05）. Analysis revealed that place of residence（effect size=-0.113），sleep disorder（effect size=-0.114） and self-assessed health status（effect size=-0.076），drinking（effect size=-0.150），and medical insurance reimbursement policies for outpatient cost for special chronic diseases（effect size=0.126） were directly associated with medication compliance. Hypertension course（effect size=0.020） and monthly antihypertensive drug costs and the percentage of such costs（effect size=0.044） that could be reimbursed according to the medical insurance reimbursement policies for outpatient cost for special chronic diseases had an indirect effect on medication compliance. Sleep disorders caused by life stresses had an indirect effect on medication compliance（effect size=-0.023）（P<0.05）. Conclusion　The medication compliance of this population needs to be further improved. To achieve this，health education delivered by medical workers should be strengthened，and life stresses associated with sleep disorders should be reduced. Moreover，policymakers are suggested to adjust the reimbursement standard for outpatient cost for special chronic diseases and increase the reimbursement rate.

Key words: Hypertension, Community health care, Medication compliance, Root cause analysis, Path analysis

摘要： 背景　服药依从性是决定高血压患者药物治疗是否有效的关键环节。了解高血压患者的服药依从性现状及其影响因素对提高患者的血压控制率具有重要意义。目的　了解社区老年高血压患者服药依从性，探讨各因素对服药依从性的影响路径，以期为医疗卫生人员制定改善服药依从性的措施提供参考依据。方法　于2017年7—8月，采用典型抽样的方法选择某市城市3个社区和2个团场社区（农村）1 157例老年高血压患者进行面对面问卷调查。问卷内容包括患者基本情况及服药依从性情况。基于安德森模型采用路径分析方法分析服药依从性影响因素间的相互关系。共收集调查问卷1 157份，有效问卷1 090份，问卷有效率为94.20%。结果　1 090例社区老年高血压患者中男396例（36.33%），女694例（63.67%）；平均年龄为（73.5±7.3）岁；服药依从率为63.21%（689/1 090）。不同倾向特征（居住地）、使能资源（门诊特殊慢性病政策、生活压力、每月降压药费用）、需求因素（自评健康、睡眠障碍）、健康行为（饮酒）的高血压患者服药依从性比较，差异有统计意义（P<0.05）；服药依从性好和依从性差的患者平均共患慢性病数量、平均高血压病程比较，差异有统计学意义（P<0.05）。居住地（效应值=-0.113）、睡眠障碍（效应值=-0.114）、自评健康（效应值=-0.076）、饮酒（效应值=-0.150）、门诊特殊慢性病政策（效应值=0.126）对服药依从性产生直接效应（P<0.05）。高血压病程（效应值=0.020）和每月降压药费用（效应值=0.044）通过门诊特殊慢性病政策产生间接作用；生活压力（效应值=-0.023）通过需求因素（睡眠障碍）产生间接作用（P<0.05）。结论　社区老年高血压患者的服药依从性有待进一步改善，医疗卫生人员应注意对患者科学宣教，缓解其生活压力，减少因睡眠障碍而带来的服药不依从现象。决策者在制定门诊特殊慢性病政策时应适当调整政策的申请标准及提高对患者的补偿力度。

关键词: 高血压, 社区卫生保健, 服药依从性, 影响因素分析, 路径分析