房颤患者华法林自我管理现状及影响因素调查
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摘要
目的了解房颤患者华法林自我管理现状,并探讨其影响因素,为房颤患者华法林自我管理干预措施的制定提供依据。方法便利抽取221例在心内科门诊就诊的口服华法林抗凝治疗的房颤患者,采用疾病感知问卷、服药信念量表与房颤患者口服华法林自我管理量表进行调查。结果房颤患者口服华法林自我管理总分为(31.93±5.51)分,疾病感知总分为(52.56±9.63)分,服药信念总分中位数为0.50分;不同居住方式、服药种数以及有无出血史患者口服华法林自我管理评分比较,差异有统计学意义(P<0.05,P<0.01)。房颤患者口服华法林自我管理总分与疾病感知总分、服药必要信念呈正相关(均P<0.05),与服药顾虑信念呈负相关(P<0.05)。多元逐步回归分析结果显示,疾病感知总分、服药必要信念与服药顾虑信念是房颤患者口服华法林自我管理的主要预测变量(调整R~2=0.882)。结论护理人员应关注房颤患者口服华法林自我管理水平,采取措施提高患者疾病感知水平,树立积极的服药信念,以提高患者口服华法林自我管理能力。
Objective To understand the status quo of self-management of warfarin therapy in patients with atrial fibrillation, to explore the influencing factors, and to provide references for intervention measures for improvement of warfarin therapy self-management in the patients.Methods Totally, 221 patients with atrial fibrillation treated with oral warfarin anticoagulant therapy in the outpatient department of cardiology were selected and investigated with the Brief Illness Perception Questionnaire, the Beliefs about Medicines Questionnaire and Oral Warfarin Self-management Scale.Results Patients with atrial fibrillation scored(31.93±5.51) points in warfarin therapy self-management,(52.56±9.63) points in disease perception, and a median of 0.50 points in medication belief. Warfarin therapy self-management scores had significant differences among patients living alone or not, taking various numbers of drugs, and having bleeding history or not(P<0.05,P<0.01).Warfarin therapy self-management was positively correlated with illness perception and medication necessity belief, while negatively correlated with medication concerns belief(P<0.05 for all).Multiple linear regression analysis showed that, illness perception, medication necessity belief, and medication concerns belief were major predictors of warfarin therapy self-management(adjusted R~2=0.882).Conclusion Nursing staff should pay attention to self-management level of warfarin therapy in patients with atrial fibrillation, take active measures to improve patients′ di-sease perception level, and help them foster positive medication belief, so as to improve patients′ self-management ability of oral warfarin therapy.
Objective To understand the status quo of self-management of warfarin therapy in patients with atrial fibrillation, to explore the influencing factors, and to provide references for intervention measures for improvement of warfarin therapy self-management in the patients.Methods Totally, 221 patients with atrial fibrillation treated with oral warfarin anticoagulant therapy in the outpatient department of cardiology were selected and investigated with the Brief Illness Perception Questionnaire, the Beliefs about Medicines Questionnaire and Oral Warfarin Self-management Scale.Results Patients with atrial fibrillation scored(31.93±5.51) points in warfarin therapy self-management,(52.56±9.63) points in disease perception, and a median of 0.50 points in medication belief. Warfarin therapy self-management scores had significant differences among patients living alone or not, taking various numbers of drugs, and having bleeding history or not(P<0.05,P<0.01).Warfarin therapy self-management was positively correlated with illness perception and medication necessity belief, while negatively correlated with medication concerns belief(P<0.05 for all).Multiple linear regression analysis showed that, illness perception, medication necessity belief, and medication concerns belief were major predictors of warfarin therapy self-management(adjusted R~2=0.882).Conclusion Nursing staff should pay attention to self-management level of warfarin therapy in patients with atrial fibrillation, take active measures to improve patients′ di-sease perception level, and help them foster positive medication belief, so as to improve patients′ self-management ability of oral warfarin therapy.
引文
[1] 卢冰清,汪小华,杨小芳,等.房颤服用华法林患者自我管理现状调查及影响因素分析[J].中国护理管理,2018,18(11):1535-1539.
[2] Clarkesmith D E,Pattison H M,Khaing P H,et al.Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation[J].Cochrane Database Syst Rev,2017(4):CD008600.
[3] Auyeung V,Patel J P,Abdou J K,et al.Anticoagulated patient′s perception of their illness,their beliefs about the anticoagulant therapy prescribed and the relationship with adherence:impact of novel oral anticoagulant therapy-study protocol for The Switching Study:a prospective cohort study[J].BMC Hematol,2016,16(1):22.
[4] Wang Z,Du X,Wang W,et al.Long-term persistence of newly initiated warfarin therapy in Chinese patients with nonvalvular atrial fibrillation[J].Circ Cardiovasc Qual Outcomes,2016,9(4):380-387.
[5] Mousavi F,Rozsa S,Nilsson T,et al.Personality and intelligence:persistence,not self-directedness,cooperativeness or self-transcendence,is related to twins′ cognitive abilities[J].Peer J,2015,3:e1195.
[6] Viktil K K,Fr?yland H,Rogvin M,et al.Beliefs about medicines among Norwegian outpatients with chronic cardiovascular disease:table 1[J].Eur J Hosp Pharm,2014,21(2):118-120.
[7] 于晓燕,曾伟.永久性心房颤动患者服药信念与服药依从性的调查研究[J].泰山医学院学报,2016,37(12):1376-1378.
[8] 向伟,王禹川,刘芳,等.CHADS2评分与CHA2DS2-VASc评分优劣性比较[J].中华心血管病杂志,2014,42(5):389-391.
[9] Broadbent E,Wilkes C,Koschwanez H,et al.A systematic review and meta-analysis of the Brief Illness Perception Questionnaire[J].Psychol Health,2015,30(11):1361-1385.
[10] 梅雅琪,李惠萍,杨娅娟,等.中文版疾病感知问卷简化版在女性乳腺癌患者中的信效度检验[J].护理学报,2015,22(24):11-14.
[11] Elizabeth B,Keith J P,Jodie M,et al.The Brief Illness Perception Questionnaire[J].J Psychosom Res,2006,60(6):631-637.
[12] Horne R,Weinman J.Patients′ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness.[J].J Psychosom Res,1999,47(6):555-567.
[13] 司在霞,周敏,曹广庆,等.中文版服药信念特异性问卷用于换瓣术后抗凝患者的信效度检验[J].护理学杂志,2013,28(4):20-23.
[14] 卢冰清,童淑萍,惠杰,等.房颤服用华法林患者自我管理量表的编制及信度效度检验[J].中国护理管理,2018,18(6):761-765.
[15] Miyazaki M,Nakashima A,Nakamura Y,et al.Asso-ciation between medication adherence and illness perceptions in atrial fibrillation patients treated with direct oral anticoagulants:an observational cross-sectional pilot study[J].Plos One,2018,13(9):e204814.
[16] 王丹华.冠心病患者主观幸福感与疾病感知控制的相关性分析[D].沈阳:中国医科大学,2018.
[17] 司在霞.机械瓣膜置换术后出院患者服用华法林依从性及其预测因素研究[D].济南:山东大学,2013.
[18] Mayet A Y.Patient adherence to warfarin therapy and its impact on anticoagulation control[J].Saudi Pharm J,2016,24(1):29-34.
[19] Mosleh S M,Almalik M M.Illness perception and adherence to healthy behaviour in Jordanian coronary heart disease patients[J].Eur J Cardiovasc Nurs,2014,15(4):223-230.
[20] Greco A,Steca P,Pozzi R,et al.The influence of illness severity on health satisfaction in patients with cardiovascular disease:the mediating role of illness perception and self-efficacy beliefs[J].Behav Med,2015,41(1):9-17.
[2] Clarkesmith D E,Pattison H M,Khaing P H,et al.Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation[J].Cochrane Database Syst Rev,2017(4):CD008600.
[3] Auyeung V,Patel J P,Abdou J K,et al.Anticoagulated patient′s perception of their illness,their beliefs about the anticoagulant therapy prescribed and the relationship with adherence:impact of novel oral anticoagulant therapy-study protocol for The Switching Study:a prospective cohort study[J].BMC Hematol,2016,16(1):22.
[4] Wang Z,Du X,Wang W,et al.Long-term persistence of newly initiated warfarin therapy in Chinese patients with nonvalvular atrial fibrillation[J].Circ Cardiovasc Qual Outcomes,2016,9(4):380-387.
[5] Mousavi F,Rozsa S,Nilsson T,et al.Personality and intelligence:persistence,not self-directedness,cooperativeness or self-transcendence,is related to twins′ cognitive abilities[J].Peer J,2015,3:e1195.
[6] Viktil K K,Fr?yland H,Rogvin M,et al.Beliefs about medicines among Norwegian outpatients with chronic cardiovascular disease:table 1[J].Eur J Hosp Pharm,2014,21(2):118-120.
[7] 于晓燕,曾伟.永久性心房颤动患者服药信念与服药依从性的调查研究[J].泰山医学院学报,2016,37(12):1376-1378.
[8] 向伟,王禹川,刘芳,等.CHADS2评分与CHA2DS2-VASc评分优劣性比较[J].中华心血管病杂志,2014,42(5):389-391.
[9] Broadbent E,Wilkes C,Koschwanez H,et al.A systematic review and meta-analysis of the Brief Illness Perception Questionnaire[J].Psychol Health,2015,30(11):1361-1385.
[10] 梅雅琪,李惠萍,杨娅娟,等.中文版疾病感知问卷简化版在女性乳腺癌患者中的信效度检验[J].护理学报,2015,22(24):11-14.
[11] Elizabeth B,Keith J P,Jodie M,et al.The Brief Illness Perception Questionnaire[J].J Psychosom Res,2006,60(6):631-637.
[12] Horne R,Weinman J.Patients′ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness.[J].J Psychosom Res,1999,47(6):555-567.
[13] 司在霞,周敏,曹广庆,等.中文版服药信念特异性问卷用于换瓣术后抗凝患者的信效度检验[J].护理学杂志,2013,28(4):20-23.
[14] 卢冰清,童淑萍,惠杰,等.房颤服用华法林患者自我管理量表的编制及信度效度检验[J].中国护理管理,2018,18(6):761-765.
[15] Miyazaki M,Nakashima A,Nakamura Y,et al.Asso-ciation between medication adherence and illness perceptions in atrial fibrillation patients treated with direct oral anticoagulants:an observational cross-sectional pilot study[J].Plos One,2018,13(9):e204814.
[16] 王丹华.冠心病患者主观幸福感与疾病感知控制的相关性分析[D].沈阳:中国医科大学,2018.
[17] 司在霞.机械瓣膜置换术后出院患者服用华法林依从性及其预测因素研究[D].济南:山东大学,2013.
[18] Mayet A Y.Patient adherence to warfarin therapy and its impact on anticoagulation control[J].Saudi Pharm J,2016,24(1):29-34.
[19] Mosleh S M,Almalik M M.Illness perception and adherence to healthy behaviour in Jordanian coronary heart disease patients[J].Eur J Cardiovasc Nurs,2014,15(4):223-230.
[20] Greco A,Steca P,Pozzi R,et al.The influence of illness severity on health satisfaction in patients with cardiovascular disease:the mediating role of illness perception and self-efficacy beliefs[J].Behav Med,2015,41(1):9-17.