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研究生:沈世珍
研究生(外文):Shih-jen Shen
論文名稱: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
論文名稱(外文):Lifestyle and Medication Adherence among Aboriginal Outpatients with Hypertension in IDS of Wanrong and Zhuoxi Counties of Hualien
指導教授:朱正一朱正一引用關係
指導教授(外文):Cheng-I Chu
學位類別:碩士
校院名稱:慈濟大學
系所名稱:公共衛生學系碩士班
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2012
畢業學年度:101
語文別:中文
論文頁數:121
中文關鍵詞:山地離島地區醫療給付效益提升計畫原住民高血壓服藥遵守行為生活模式
外文關鍵詞:IDS(Integrated Delivery SystemAborigineHypertensionMedication AdherenceLifestyle
相關次數:
  • 被引用被引用:6
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  • 下載下載:218
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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
ii
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。
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
iv
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.
第一章 緒論
 第一節 研究背景及動機 1
 第二節 研究之重要性 7
 第三節 研究目的 10
 第四節 研究問題 11
第二章 文獻查證 13
 第一節 高血壓患者服藥遵守行為及其測量方式 13
 第二節 影響高血壓服藥遵守行為的因素 17
 第三節 生活型態與高血壓的關係 20
 第四節 社會人口學與高血壓服藥遵守行為的關係 26
 第五節 生活型態與飲食習慣與高血壓服藥遵守行為的關係 29
 第六節 文獻總結 31
 第七節 研究假設與架構 31
第三章 研究方法 33
 第一節 名詞與操作型定義 33
 第二節 研究架構 34
 第三節研究過程 35
 第四節 研究對象 37
 第五節 研究工具 37
 第六節信效度檢定 39
 第七節問卷填寫 41
 第八節 資料處理與分析方法 42
第四章 研究結果 43
 第一節 研究對象社會人口學之描述性資料分析 43
 第二節 研究對象之高血壓罹病史與治療史、合併其它慢性病及血壓量測值資料 描述性分析 47
 第三節 研究對象之服藥遵守行為描述性分析 50
 第四節 研究對象之健康生活型態遵循度描述性分析 51
 第五節 研究對象之服藥遵守行為與血壓控制的關係 58
 第六節 研究對象之健康生活型態遵循度與血壓控制的關係 59
 第七節 研究對象之服藥遵守行為與健康生活型態遵循度的關係 59
 第八節 研究對象之社會人口學與服藥遵守行為之差異性分析 60
 第九節 研究對象之社會人口學與健康生活型態遵循度之差異性分析 71
 第十節多元邏輯式迴歸模型顯著性檢定 77
第五章 討論與建議 78
 第一節 描述性統計討論 78
 第二節 假設驗證 80
 第三節主要發現與建議 82
 第四節 研究限制 83
參考文獻 85
圖表
 圖一 研究架構 35
 圖二 進行步驟 36
 表一 花蓮縣萬榮鄉及卓溪鄉99年10大死因 4
 表二 花蓮縣及萬榮鄉、卓溪鄉近10年標準化死亡率與全臺及花蓮縣比較 4
 表三 國人(≧15歲)男女性、地區層級別之高血壓患者之自知率、服藥率與 控制率 5
 表四 國內外相關服藥遵守行為之重要性及量測研究文獻摘要 15
 表五 國內外對於影響高血壓服藥遵守行為的因素研究文獻摘要 18
 表六 台灣2010年高血壓治療指引對生活型態修正之建議 21
 表七 國內外探討生活型態與高血壓的關係的研究文獻摘要 24
 表八 國內外對於社會人口學與高血壓服藥遵守行為的關係研究文獻摘要 27
 表九 國內外對於生活型態與高血壓服藥遵守行為的關係研究文獻摘要 30
 表十 研究工具信度檢測分析 40
 表十一 研究對象之社會人口學分析 45
 表十二 研究對象之疾病史與治療狀況及其它慢性病分析 49
 表十三 研究對象之MMAS量表分數描述性分析 51
 表十四 研究對象之健康生活型態描述性分析 52
 表十五 研究對象各項健康生活型態遵循度描述性資料分析 53
 表十六 研究對象限鹽飲食描述性資料分析 55
 表十七 研究對象低脂飲食描述性資料分析 56
 表十八 研究對象DASH飲食描述性資料分析 57
 表十九 研究對象不健康生活型態數目描述性資料分析 58
 表二十 研究對象服藥遵守行為與血壓控制成效的關係 59
 表二十一 研究對象健康生活型態遵循度與血壓控制的關係 59
 表二十二 研究對象服藥遵守行為與健康生活型態遵循度關係 60
 表二十三 社會人口學變項與服藥遵守行為之相關分析 67
 表二十四 社會人口學變項與健康生活型態遵循度之相關分析 75
附錄
 附件一 問卷內容 103
 附件二 人體詴驗委員會同意書 (完整審查) 106
 附件三 人體詴驗委員會同意書 (修正案) 107
 附件四 原住民委員會函 108 附件五 受詴者同意書 109
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