家庭医生信任与2型糖尿病患者服药依从性的关系研究

摘要

目的 了解2型糖尿病患者对签约家庭医生信任的现状,探索医患信任对患者服药依从性的影响.方法 于2018年2—4月,采用整群系统抽样方法,对江苏省盐城市三龙镇10个农村社区、南通市平潮镇5个农村社区共1078例糖尿病患者进行问卷调查,调查内容主要包括患者信任行为与态度量表、Morisky服药依从性量表等.计量资料及计数资料分别用mean±SD、构成比进行描述性分析;采用多重线性回归分析,探讨医生信任的影响因素;嵌套有序logistic回归分析,探索医患信任与依从性之间的关系.结果 糖尿病患者对医生信任的得分为20.16±2.13,服药依从性得分为7.07±1.54.55.40％ 的糖尿病患者服药依从性较高,28.53％ 的患者依从性中等,16.07％ 的患者依从性差.多重线性回归分析表明,患者的就业状态、病程、自评健康、有抑郁症状是患者信任行为的影响因素(P<0.05).有序logistic回归分析表明,患者对医生的信任得分每增加1分,服药依从性增加11.0％(OR=1.110,P<0.001).结论 糖尿病患者对家庭医生信任,可提高患者的服药依从性.%Objective To understand the status of type 2 diabetes mellitus (T2DM) patients′ trust in their family physicians, and to explore the role of the trust on patients′ medication adherence. Methods A total of 1078 patients with T2DM were recruited by cluster and systematic sampling method, from ten rural communities in Sanlong township in Yancheng city and five rural communities of Pingchao township in Nantong city, during February to April in 2018. The survey covered their trust behavior and attitude scale (PTBAS), and an 8-item Morisky medication adherence scale ( MMAS-8). Both measurement data and enumeration data were subject to descriptive analysis by mean ± SD and proportion respectively. Multiple linear regression was employed to explore the determinants of trust in physicians. Ordered logistic regression analysis was used to explore the relationship between patient-physician trust and medication adherence. Results The mean scoring of patients′ trust and medication adherence was 20. 16 ± 2. 13, 7. 07 ± 1. 54 respectively. 55. 40 percent of the patients had high medication compliance, 28. 53 percent of them had medium compliance and 16. 07 percent had poor compliance. Multiple linear regression analysis showed that the patient′s occupation, course of disease, self-reported health status and mental health status influenced their trust behavior (P < 0. 05). Ordered logistic regression analysis showed that each 1 point increase in patient′s trust in physicians, the medication compliance increased by 11. 0％ (OR = 1. 110, P < 0. 001). Medication adherence is also affected by age, employment status, course of illness, and mental health status. Conclusions Diabetes patients′ trust in their family physicians improves their medication adherence.