| Objective:To understand the current situation of antihypertensive drug use and analyze the status of drug compliance and its influencing factors in elderly hypertension patients in the community.Provide scientific references for improving medication compliance,optimizing medication regimen for elderly hypertensive patients in the community,and improving related drug policies.Methods:This study uses a combination of quantitative and qualitative research.Three urban and two rural communities in a division city of Xinjiang Corps were selected as the research site by the typical sampling method,and conducted a face-to-face questionnaire surveys on 1090 elderly hypertensive patients in the community.Describe and analyze the demographic and sociological characteristics of patients and the utilization of antihypertensive drugs;single-factor logistic regression was used to identify the influencing factors of medication compliance in elderly hypertensive patients in the community;multi-factor logistic regression analysis was used to further explain the relevant influencing factors;use path analysis to explore the interaction between influencing factors in each dimension.In order to deeply analyze the reasons for poor compliance of elderly patients with hypertension in the community,a targeted sampling method was used to select 30 elderly patients with hypertension in the sample city and conducted a semi-structured in-depth interview with them.Analysis of interview data using Colaizzi phenomenological data analysis method.Results:1.Of the 1090 patients with hypertension,686 were treated with a single drug and 404 were treated with combined medication therapy.Among patients treated with monotherapy,CCB were taken the most(437,63.7%),followed by ARB(88,12.8%).Two drugs regimen are the main ones(335,82.9%),CCB + ARB was the majority of the two-drug regimens,accounting for 23.0% of all two-drug regimens;57 patients used triple regimens,the most commonly used triple regimen was CCB + ARB + β receptor blockers,accounting for 36.8% of all triple regimens;9 patients used quadruple regimens.The main regimen was CCB + β receptor blocker + diuretics + diuretics and ACEI + diuretics + diuretics + β receptor blockers,which accounted for 22.2% of patients with quadruple regimens;in addition,there were 3 patients using the five-drug regimen.Among 244 patients(60.4%)who used the combination,the regimen was the one recommended by the Chinese guidelines for the prevention and treatment of patients with hypertension.2.Of the 1,090 hypertensive patients investigated,689(63.2%)had good medication compliance,the medication compliance rate was moderate.3.The univariate analysis results showed that: patient-related factors(life pressure,sleep disorders,daily salt intake,drinking status);treatment-related factors(daily medication frequency,traditional Chinese medicine);socioeconomic factors(monthly antihypertensive drug costs,place of residence,education level);disease-related factors(number of comorbid chronic diseases,duration of hypertension,hypertensive selfsensory severity,self-assessed health status);medical team-health care system(outpatient medical reimbursement policy)is medication compliance influencing factors(P < 0.05).4.Multivariate logistic regression found that among the patient-related factor dimensions,the most influential factors on medication compliance were drinking status(OR=2.163,95%CI: 1.430-3.273),followed by sleep disorders(OR=1.977,95%CI: 1.446-2.704),life pressure(OR=1.444,95%CI: 1.063-1.961),daily salt intake(OR=1.429,95%CI: 1.078-1.894).In the dimension of treatment-related factors,the daily medication frequency is the influencing factor of patients’ compliance.Patients who took the drug three or more times a day tend to have worse compliance than those who take one time a day(OR=1.840,95%CI: 1.062-3.187).In terms of socioeconomic factors,patients with the cost of antihypertensive drugs of 80-140 yuan and 15-80 yuan per month had better compliance than those with the cost of antihypertensive drugs of less than 15 yuan per month(OR=0.630,95%CI: 0.426-0.932;OR=0.683,95%CI: 0.473-0.986);compared with patients living in urban communities,patients living in rural communities had poor compliance to medication(OR=1.422,95%CI: 1.077-1.879).In the dimension of disease-related factors,patients with poor self-assessed health status tended to have worse compliance than patients with good self-assessed health status(OR=1.509,95%CI: 1.033-2.203);in addition,patients with less hypertensive self-sensory severity had worse compliance than those without hypertensive self-sensory severity(OR=1.386,95%CI: 1.033-1.859).In the dimension of medical team-health care system factor dimension,patients who had outpatient medical reimbursement policy had better medication compliance than patients who did not have the policy(OR=0.716,95%CI: 0.523-0.979).5.Path analysis results showed that place of residence(predisposing characteristics),sleep disorder(need),self-assessed health status(need),drinking(health behaviors),and outpatient medical reimbursement policy had a direct effect on medication compliance.Duration of hypertension(need)and monthly antihypertensive drug costs(enabling resources)have an indirect effect on medication compliance through outpatient medical reimbursement policy(B=-0.020,P=0.049;B=-0.044,P=0.032);life pressure(enabling resources)have an indirect effect on medication compliance through sleep disorders(need)(B=0.023,P=0.017).6.The qualitative research results found that the main influencing factors of patients’ poor medication compliance were: patient-related factors(weak health awareness,forgetfulness);medical team-health care system factors(poor availability of commonly used drugs,community hypertension management not in place);treatment-related factors(worrying about drug side effects).Conclusion:CCB and ARB are the main used antihypertensive drugs for the elderly in the community.Most of the patients used single drug,and most of them basically met the requirements of the Chinese guidelines for the prevention and treatment of patients with hypertension,but there are still some patients using unreasonable drug regimens,among which the phenomenon of repeated drug use is common.The compliance rate of community elderly patients with hypertension is high,but it still needs to be further improved.In terms of the influencing factors of medication compliance,outpatient medical reimbursement policy has an important impact on medication compliance,duration of hypertension and monthly antihypertensive drug costs have an indirect effect through outpatient medical reimbursement policy.Sleep disorder is an intermediary variable between medication compliance and life pressure,life pressure have an indirect effect through sleep disorders. |
