| BackgroundPercutaneous coronary intervention was carried out in clinical practice since the1970s, with the accumulation of experience, improvement of equipment and medical technical level, PCI indications continue to expand, gradually reduce complications,which has become an important means of treatment of coronary artery disease(CAD). But after PCI secondary prevention medication is still one of the basic strategy for CAD prevention. Evidence-based medicine have proved that PCI was treated with antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statin drug can significantly reduce cardiovascular risk events occur after PCI.Medication adherence plays a vital role in secondary prevention of coronary heart disease. With the level of medical technology continues to improve and change of medical model, People have gradually realized that the traditional result of the treatment of disease-survival and symptom relief was no longer necessarily the most important results. Reduce the fatality rate is one of the best indicator of coronary artery disease treatment, but only mortality study indicators to evaluate this ill survival status, is not enough. We must not only attach importance to the improvement of all the physiological parameters in patients with PCI, but also should focus on the impact of treatment on the patient’s overall health status and should pay attention to the improvement of quality of life of. A large mumber of research have paid attention to medication adherence and quality of life at home and abroad,but the majority of these have focus on investiation of medication adherence status and influencing factors, status of quality of life and the impact factors.Little has attempted to find the correlation between medication adherence and quality of life. Most research on quality of life in patients with coronary heart disease have only used one scale, and on abroad studies about quality of life recommend using of disease-specific quality of life scale and pervasive quality of life scale combination of a comprehensive evaluation of quality of life. The use of quantitative research on the impact of medication compliance impact factor, few qualitative interviews from a patient’s own point of view was starting to understand PCI patient’s own idea on medication.Based on the above research status, this study used the Seattle Angina Questionnaire (SAQ) and SF-36to evaluate quality of life of patients after PCI analysis of the correlation between medication adherence and quality of life, in-depth analysis and through qualitative interviews the impact of medication adherence factors, the development of personalized interventions to improve medication compliance, thereby improving quality of life.PurposesTo investigate medication compliance status of patients after PCI and analysis of impact factors on medication adherence.Then ananysis of the correlation between medication adherence and quality of life, combined with in-depth analysis of the impact of medication adherence factors,formulating personalized care interventions through quantitative research and qualitative research to medication adherence after PCI and ultimately improving quality of life.Methods1.Medication adherence and quality of life evaluation:medication adherence using the Morisky questionnaire, quality of life using the SAQ and SF-36combined to evaluate quality of life of patients after PCI.2.During the first phase included in the403PCI patients after medication compliance and its influence factors, and medication adherence between the quality of life analysis.3.The second phase through qualitative interviews with10after PCI in patients taking cognitive-depth analysis of specific factors that affect medication adherence.4. Based on the research results of the first two chapters to develop personalized interventions included141cases after PCI patients to improve medication ahereence.Interventions include watching video of coronary heart disease, health education guidance (diet, exercise.knowledge of drugs), dispensing training, telephone interviews, warm and short message alerts, to build a harmonious nurse-patient relationship.Medication adherence and quality of life six months after the intervention was evaluated. The first part of the403cases as control group, the third part of the141patients as the intervention group to compare, comparing quality of life and medication compliance of both group, testing the effectiveness of interventions.Results1. Medication adherence of patients after PCI postoperative six monthsThe overall compliance score accounted for the largest proportion, followed by three points, two points less,0points and1point only a small proportion, that is, full compliance accounted for the highest proportion. Aspirin degree of compliance is the highest,67.7percent of patients fully compliant, while the other three drugs fully comply with only about50percent,2points and3points in proportion.2.Socio-demographic factors on medication adherenceSingle factor non-parametric tests screen out six variables which have significant differences on medication adherence of the four drugs were gender (Z=-4.338,-4.023.-3.622,-2.564, P<0.05), age (χ2=21.701,39.036,25.976,25.439, P<0.05), whether they were serving (Z=-3.342,-3.983,-3.397,-3.406, P<0.05), medication expenditures (χ2=9.159,16.402,17.017,13.867, P<0.05), taking the number of (χ2=7.238,10.141,13.619,15.646, P<0.05), medical treatment convenient or not (χ2=12.348,6.890,9.469,9.989, P<0.05). One of the three drugs, medication compliance marital status (P=0.013,0.008,0.173,0.006),medical insurance (P=0.076,0.013,0.001,0.026),number of complications(χ2=4.571,10.562,14.689,12.004, P=0.260,0.014,0.002,0.007). National medication compliance of a drug only to have a significant effect (P=0.089,0.009,0.080,0.146), education level and drug knowledge level of understanding of the four drugs, medication adherence had no effect (P>0.05).Hierarchical logistic regression analysis showed that gender, working conditions, taking the number of drug knowledge of these four variables on Aspirin medication adherence affect (P<0.05), male (OR=0.290, P<0.001), leaving (OR=3.764, P=0.007), over six kinds of medication (OR=3.483, P=0.032). a clear knowledge of drugs (OR=0.371. P=0.017). The risk factors for medication compliance. gender, age, work status, educational level four variables on ACEI medication adherence influential male (OR=.397,P<0.001), older (OR=1.058, P=0.001), separation (OR=2.584. P=.0159), higher educational level (OR=0.326,P=.0410) of its risk factors. Gender, age. work status, the four variables of knowledge of drugs on the BBs medication adherence affect (P<0.05), male (OR=0.408, P<0.001), older (OR=1.033, P=0.043), jobless (OR=3.764, P=0.018), a clear understanding of the knowledge of drugs (OR=0.372, P=0.003) the risk factors. Gender, age, these two variables on Statins medication adherence affect (P<0.05), male (OR=0.560, P=0.007), older (OR=1.030, P=0.0491) are its dangerous factors.3.The correlation of medication compliance with the SF-36quality of life dimensions Four types of drugs, medication adherence were significantly related to the dimensions physical function, role-physical, bodily pain, general health, vitality (P<0.05), while the social function, role-emotional, mental health, these three dimensions with four drugs medication compliance nosignificant correlation (P>0.05). physical function, role-physical, bodily pain, general health, these four dimensions are physical health, the description of medication adherence and physical health was significantly related to mental health is only a dimension of vitality and medication adherence was significantly associated.4. Medication compliance SAQ quality of life dimensions related to the five dimensions, four drug medication compliance with physical limitation, angina stability, angina frequency, the treatment satisfaction the four dimensions showed a significant correlation (P<0.05).ACE inhibitors, BBs medication adherence and disease perception were significantly (P<0.05), aspirin, statins, and disease perceptin were significantly (P>0.05).5.PC I postoperative quality of life in physical health, social function compared with the preoperative significant increase (P<0.05), role function, vitality, mental health dimension, treatment satisfaction, disease awareness level of preoperative and postoperativesignificant difference (P>0.056.The intervention group and control group Patients with medication compliance comparative analysis of two groups of patients with various types of drugs, medication adherence contrast there were significant differences (P<0.05), control group of patients with various types of drugs mean rank lower than the intervention group patients.Patients of the intervention group significantly higher than that in patients with medication compliance.7. Between the two groups in patients with SAQ dimensions compared two groups were analyzed in the body activity is limited (t=23.104, P<0.001), angina steady state (t=7.415, P<0.001), onset of angina (t=5.504, P<0.001), degree of treatment satisfaction (t=12.723, P<0.001), disease awareness level (t=2.387, P=0.017) of these five scores are significant differences in the control group patientsscores were lower than the intervention group patients, showed that the intervention of the five dimensions of the group of patients compared with the control group improved.8.The two groups of patients with the SF-36dimensions compared two groups of patients in the physiological function (t=-13.950, P<0.001), physiological functions (t=-10.277. P=0.013), bodily pain (t=-5.845, P<0.001), general health (t=-6.726, P<0.001), role emotional (t=-4.815, P=0.005), social function (t=-4.270, P=0.007) of these five dimension scores were significantlydifference, while the mental health vitality of these two dimensions was no significant difference (P>0.05).Conclusions1.Overall medication adherence after PCI. Aspirin-type drugs is fully compliant,67.7%, ACE inhibitors50.1%,49.1%in BBs called statins52.4%, only about50%of full compliance of the latter three drugs, about half of the patients did not take prescribed medicine.2. Impact after PCI, medication compliance sociodemographic factors, this study univariate and multivariate analysis showed that the gender, age, whether they were serving, drugs, spending, taking the number to seek medical treatment or not, whether there are health insurance,number of complications, drug knowledge, educational level, marital status, these11variables after PCI in patients with medication compliance to varying degrees, female, younger, employed, a smaller proportion of the total income of medical expenses, taking the number of relatively small, convenient medical care, medical insurance, a small number of complications, better compliance of patients with these conditions.3. After PCI in patients with medication compliance and quality of life after PCI in patients with medication compliance with the SF-36physical health (PF, the RH, BP, GH), was significantly related to mental health only significantly associated with VT. SAQ PL (physical activities limited extent), AS (the degree of angina pectoris), AF (the number of angina pectoris), TS (treatment satisfaction) of these four dimensions are related to medication adherence was significantly related to The DP (the disease) with ACE inhibitors, BBs either drug compliance. The findings of these two tables show that medication adherence and quality of life in physical health was significantly associated with the part of mental health dimension.4. After PCI, most patients will take active measures to improve medication adherence behavior, but because of age, economic reasons, cognitive efficacy and side effects, their families and the people around them, medical personnel, economic status and health care system, and other factors, patients medication compliance is not so good performance.5. According to the individual patient to formulate a comprehensive interventions to improve after PCI in patients with medication compliance, and can have a positive impact on the quality of life of patients, especially cardiac function and physical health can improve patient satisfaction andunderstanding of the disease and reduce the impact of sociodemographic factors on medication adherence, and no significant effect on psychological health. |
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