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原住民高血壓患者生活型態與服藥遵守行為之探討 --以花蓮縣萬榮及卓溪鄉IDS門診病患為例

Lifestyle and Medication Adherence among Aboriginal Outpatients with Hypertension in IDS of Wanrong and Zhuoxi Counties of Hualien

作者:沈世珍
畢業學校:慈濟大學
出版單位:慈濟大學
核准日期:2012-10-19
類型:Electronic Thesis or Dissertation
權限:Copyright information available at source archive--Tzu Chi University....

中文摘要

山地離島地區醫療給付效益提升計畫(以下簡稱IDS)自民國88年實施迄今已經12年,雖然民眾就醫環境略有改善,但原住民死亡率未見下降,以花蓮縣萬榮鄉及卓溪鄉為例,其死亡率仍明顯偏高。儘管研究顯示,自IDS開辦以後,民眾就醫之可近性、便利性皆有改善,花費的金錢與時間也減少,但在高血壓的治療效果上,未見預期效果。高血壓與相關之T血管疾病、心臟病等三項,始終名列十大死因之內,且民國99年花蓮縣萬榮與卓溪鄉IDS各診療站民眾治療高血壓之次數與花費皆排名第一。 血壓控制不佳的原因,分為藥物及非藥物的因素。藥物因素以未遵醫囑服藥為主;而非藥物因素以不健康的生活型態為主,此亦為罹患慢性病及造成死亡的重要原因。原住民是IDS服務範圍內主要的族群,一般有較高的身體質量指數(BMI)及特殊的飲酒、嚼檳榔和飲食習慣,與高血壓之間的關係值得探討。本研究從IDS看診的高血壓患者中篩選出適當的樣本,進行調查訪視,收集資料,再進行統計分析,希望對IDS高血壓病患服藥遵醫囑行為現況,生活型態中對戒煙、節酒、戒檳榔、減重、多運動、限鹽及健康飲食習慣等遵循情形,作一評估及分析。
本研究篩選自100年7月以後有IDS看診記錄的原住民高血壓患者187人,完成調查訪視及資料收集。統計分析結果發現與服藥遵守行為有關的為有工作(卡方值6.757,顯著性0.034)同時服用多種藥物(卡方值7.895,顯著性0.019)、嚼食檳榔的生活習慣(卡方值16.074,顯著性0.041)等;與健康生活型態遵循度有關的為有工作(卡方值8.646,顯著性0.013)、BMI≦27(卡方值7.580,顯著性0.023)、家屬有人罹患高血壓(卡方值17.713,顯著性0.001)等。服藥遵守行為與血壓控制成效之間呈顯著正相關(卡方值19.281,顯著性0.000);健康生活型態遵循度與血壓控制成效之間亦呈顯著正相關(卡方值7.247,顯著性0.027)。惟服藥遵守行
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為與健康生活型態遵循度之間未見顯著相關(卡方值2.948,顯著性0.567)。 由本研究結果得知減少嚼食檳榔、積極減重、安排就業使有固定工作等,應可有效改善山地離島地區居民(尤其是原住民)高血壓患者的服藥及生活型態之遵守行為,進一步增進血壓控制成效。在衛教方面,對於高血壓疾病及藥物的說明與講解,應可增進個案對病情與藥物的了解與配合,改進血壓控制成效。

英文摘要

The Bureau of National Health Insurance (NHI) has implemented Integrated Delivery Systems (IDS) in all the mountain villages since 1996, but the mortality rate among aboriginal people remains high. Hypertension was the most important and frequent diagnosis in the OPD records of Wanrong and Zhouxi IDS service, also was the first medical expenditure in 2010. Hypertension and its related diseases such as stroke and coronary heart disease were in the list of ten leading causes of mortality for several years. Although most of the investigations concluded that the residents were agreed that IDS being helpful to the doctor consultation accessibility, saving money and time, but the treatment result of hypertension was not satisfied. The reasons of poor therapeutic effects of hypertension treatment include pharmacological and non-pharmacological factors, the pharmacological factor is non-adherence to medications, and the non-pharmacological factor is un-healthy lifestyle. Lalonde (1974) indicated that the reasons of most diseases and deaths were related to lifestyle. The majority people lived in the area of Wanrong and Zhouxi are aborigines, they had characteristics of higher BMI, alcohol consumption, betel nuts chewing and some special diet, it might be worthy to investigate the associations between these lifestyle factors and high prevalence of hypertension.
Our study population is hypertension cases from outpatient of IDS, we had investigated 291 cases who came to OPD for hypertension treatment from 2011 July to Dec 31th, by telephone and made appointment, 198 participates had completed a structured questionnaire including items of sociodemographic factors, adherence to medications and lifestyle behavior. We also review the medical records of medicine
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regimen, attendance to appointments. Our result revealed that the control of hypertension and the extent of adherence to medications were strong related (Chi square=19.281, P=0.000 ) The control of blood pressure also had correlations to healthy lifestyle modifications (Chi square=7.247, P=0.027). But there was no correlations between adherence to medications and healthy lifestyle modifications (Chi square=2.948, P=0.567) . We found that having a job (Chi square=8.757, P=0.034) size of BMI (Chi square=7.895, P=0.019) and betel nuts chewing (Chi square=16.074, P=0.041) all had correlations with the behavior of adherence to medications; The factors which had correlations to adherence of lifestyle include had a job (Chi square=8.646, P=0.013), BMI 27(Chi square=7. 580, P=0.023) , and had family history of hypertension (Chi square=17.713, P=0.001). We concluded that quit betel nut chewing, body weight reduction and a stable job could increase the effectiveness of blood pressure control by enhancing the adherence of medication and lifestyle modification. More detailed introduction and explanation of the hypertensive disease and drugs used, might also improve the effectiveness of blood pressure control through better understanding and cooperation.

 

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