基于用药安全5时刻的健康教育模式在COPD患者吸入药物依从性中的应用

doi:10.3760/cma.j.cn441417-20250102-15030

摘要/Abstract

摘要：

目的　探讨用药安全5时刻理念在慢性阻塞性肺病（COPD）患者吸入药物依从性中的应用效果。方法　本研究为随机对照试验。选取2024年6月至2024年12月在广州医科大学附属第一医院住院的320例COPD急性期患者作为研究对象。采用随机数字表法，将患者分为试验组和对照组，各160例。对照组男140例，女20例；年龄（67.67±9.94）岁；病程（10.91±9.14）年。试验组失联2例、病情加重退出研究2例。试验组男126例，女30例；年龄（68.96±9.16）岁；病程（11.72±9.12）年。对照组采用常规护理干预，试验组在对照组基础上采取用药安全5时刻健康教育方案干预。两组均连续干预3个月。比较两组一般资料，干预3个月后用药知识问卷、用药信念问卷、中文版吸入药物依从性测试（TAI）得分。采用单因素方差分析和χ²检验进行统计学分析。结果　干预3个月后，试验组用药知识问卷、用药信念问卷和中文版TAI得分均高于对照组［（27.23±8.73）分比（21.86±9.86）分、（51.46±9.40）分比（42.91±10.39）分、（46.00±6.48）分比（38.58±10.33）分］（均P<0.05）。结论　应用用药安全5时刻原则指导COPD患者吸入药物治疗，可提高吸入药物认知水平和依从性，优化吸入药物的长期管理模式。

关键词:

font-family:Calibri, font-size:10.5pt, "> font-size:9pt, ">慢性阻塞性肺病；font-size:9pt, ">吸入药物依从性；font-size:9pt, ">用药安全font-size:9pt, ">5font-size:9pt, ">时刻；font-size:9pt, ">健康教育

Abstract:

Objective　To explore the application effect of the "five moments for medication safety" concept in the adherence to inhaled medication of patients with chronic obstructive pulmonary disease (COPD). Methods　This study is a randomized controlled trial. A total of 320 patients with acute COPD who were hospitalized at the First Affiliated Hospital of Guangzhou Medical University from June 2024 to December 2024 were selected as the study subjects. Using the random number table method, the patients were divided into the experimental group and the control group, with 160 cases in each group. There were 140 males and 20 females in the control group, aged (67.67±9.94) years, course of the disease (10.91±9.14) years. In the experimental group, 2 cases were lost to follow-up and 2 cases withdrew from the study due to worsening conditions. There were 126 males and 30 females in the experimental group, aged (68.96±9.16) years, course of the disease (11.72±9.12) years. The control group received conventional nursing intervention, while the experimental group was given the health education model based on the five moments for medication safety on top of the intervention provided by the control group. Both groups were subjected to continuous intervention for 3 months. The general data were compared between the two groups, as well as the scores of the medication knowledge questionnaire, medication belief questionnaire, and the Chinese version of the adherence to inhaled medication test (TAI) after 3 months of intervention. One-way analysis of variance, and χ² test were used for statistical analysis. Results　After 3 months of intervention, the scores of the medication knowledge questionnaire, medication belief questionnaire and the Chinese version of TAI in the experimental group were all higher than those in the control group [(27.23±8.73) points vs. (21.86±9.86) points, (51.46±9.40) points vs. (42.91±10.39) points, (46.00±6.48) points vs. (38.58±10.33) points] (all P<0.05). Conclusion　Applying the five moments for medication safety to guide the inhalation medication treatment for COPD patients can enhance their understanding and adherence to inhaled medication, and optimize the long-term management model of inhalation medication.

Key words:

font-family:Calibri, font-size:10.5pt, "> font-size:9pt, ">Chronic obstructive pulmonary disease；Adherence to inhaled medication；five moments for medication safety；Health education

黄平曾秋璇陈文利杨旭林晓红黄惠欣董环.

基于用药安全5时刻的健康教育模式在COPD患者吸入药物依从性中的应用 [J]. 国际医药卫生导报, 2025, 31(15): 2616-2621.

Huang Ping, Zeng Qiuxuan, Chen Wenli, Yang Xu, Lin Xiaohong, Huang Huixin, Dong Huan.

Application of the health education model based on the five moments for medication safety in the adherence to inhaled medication of patients with COPD [J]. International Medicine and Health Guidance News, 2025, 31(15): 2616-2621.

参考文献

[1] 陈典,隆寰宇,李姝润,等.2024年GOLD慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读[J].中国全科医学,2024,27(13):1533-1543,1567.DOI:10.12114/j.issn.1007-9572.2023.0867.

[2] He R, Wang Y, Ren X, et al. Associations of medication regimen complexity with medication adherence and clinical outcomes in patients with chronic obstructive pulmonary disease: a prospective study[J]. Ther Adv Respir Dis, 2023, 17:17534666231206249. DOI: 10.1177/17534666231206249.

[3] Kim JA, Lim MK, Kim K, et al. Adherence to inhaled medications and its effect on healthcare utilization and costs among high-grade chronic obstructive pulmonary disease patients[J]. Clin Drug Investig, 2018, 38(4):333-340. DOI: 10.1007/s40261-017-0612-2.

[4] Vestbo J, Anderson JA, Calverley PM, et al. Adherence to inhaled therapy, mortality and hospital admission in COPD[J]. Thorax, 2009, 64(11):939-943. DOI: 10.1136/thx.2009.113662.

[5] López-Campos JL, Quintana Gallego E, Carrasco Hernández L. Status of and strategies for improving adherence to COPD treatment[J]. Int J Chron Obstruct Pulmon Dis, 2019, 14:1503-1515. DOI: 10.2147/COPD.S170848.

[6] Humenberger M, Horner A, Labek A, et al. Adherence to inhaled therapy and its impact on chronic obstructive pulmonary disease (COPD)[J]. BMC Pulm Med, 2018, 18(1):163. DOI: 10.1186/s12890-018-0724-3.

[7] Wurst KE, St Laurent S, Mullerova H, et al. Characteristics of patients with COPD newly prescribed a long-acting bronchodilator: a retrospective cohort study[J]. Int J Chron Obstruct Pulmon Dis, 2014, 9:1021-1031. DOI: 10.2147/COPD.S58258.

[8] Zeng Y, Cai S, Chen Y, et al. Current status of the treatment of COPD in China: a multicenter prospective observational study[J]. Int J Chron Obstruct Pulmon Dis, 2020, 15:3227-3237. DOI: 10.2147/COPD.S274024.

[9] Toyama T, Kawayama T, Kinoshita T, et al. Differences in adherence barriers to inhaled medicines between Japanese patients with chronic obstructive pulmonary disease and asthma evaluated using the "Adherence Starts with Knowledge 20" (ASK-20) questionnaire[J]. Intern Med, 2019, 58(2):175-185. DOI: 10.2169/internalmedicine.0488-17.

[10] Jansen EM, van de Hei SJ, Dierick BJH, et al. Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers[J]. J Thorac Dis, 2021, 13(6):3846-3864. DOI: 10.21037/jtd-20-2360.

[11] 李军,潘艳萍,王春华,等. 综合干预和健康教育在慢性阻塞性肺疾病患者吸入性药物使用中的应用效果[J]. 国际医药卫生导报,2022,28(17):2442-2446. DOI:10.3760/cma.j.issn.1007-1245.2022.17.016.

[12] 刘舒,谢新芳,金培英,等. 慢性阻塞性肺疾病病人吸入剂使用依从性的研究进展[J]. 全科护理,2021,19(9):1184-1187. DOI:10.12104/j.issn.1674-4748.2021.09.008.

[13] 陈娜,李珍,袁平,等. 基于用药安全"5个时刻"探讨糖尿病患者用药安全现状及影响因素[J]. 中国医药导报,2022,19(14):48-51,64.

[14] 谢欣欣,王晓灿,吕冶芳,等. 基于单元的综合安全项目在冠心病患者口服用药中的应用[J]. 护理学报,2023,30(13):74-78. DOI:10.16460/j.issn1008-9969.2023.13.074.

[15] 谢小敏,赵焕,张焱梅,等. "5个时刻法"在慢性阻塞性肺疾病患者药物治疗管理中的应用效果[J]. 广西医学,2022,44(14):1578-1582. DOI:10.11675/j.issn.0253-4304.2022.14.04.

[16] 马向芹. 我国老年慢性病患者患病及用药状况研究[D]. 郑州:河南大学,2015. DOI:10.7666/d.D760439.

[17] 孟静,季诗明,郭红,等. 慢性心力衰竭患者服药相关信念问卷的编制及信效度检测[J]. 护理管理杂志,2015(7):471-473,480.

[18] 孟玮玮,崔亚楠,罗丽娟,等. 吸入药物依从性测试中文版的信效度研究[J]. 中华结核和呼吸杂志,2022,45(5):423-430. DOI:10.3760/cma.j.cn112147-20211108-00783.

[19] 张玉,李娟,朱仁婕. 阶段性激励教育联合趣味性健康教育对儿童弱视训练依从性、家长认知度的影响[J]. 国际护理学杂志,2024,43(1):134-138. DOI:10.3760/cma.j.cn221370-20221205-00033.

[20] 汪敏生,龚洁,严亚琼,等. 高血压知识对老年高血压患者服药依从性影响研究[J]. 中国社会医学杂志,2018,35(3):252-255. DOI:10.3969/j.issn.1673-5625.2018.03.011.

[21] Nguyen T, Truong MTX, Lam DN, et al. Effectiveness of clinical pharmacist intervention on medication adherence in patients with chronic obstructive pulmonary disease - a randomized controlled study[J]. Patient Educ Couns, 2024, 118:108037. DOI: 10.1016/j.pec.2023.108037.

[22] 齐晶晶,刘腊梅,李文婷,等. 疾病感知和服药信念在脑卒中患者自我效能和康复依从性中的作用分析[J]. 中国康复,2024,39(7):401-405. DOI:10.3870/zgkf.2024.07.004.

[23] 陈腊年,李小峰,孙玉梅. 多学科教育干预模式对经皮冠状动脉介入术后患者健康认知和治疗依从性的影响[J]. 解放军护理杂志,2017,34(23):21-25. DOI:10.3969/j.issn.1008-9993.2017.23.005.

[24] 赵宁,赵巍,刘爱斌,等. 基于知信行理论的多学科干预对提高脑瘫患儿照顾者参与家庭康复训练的依从性[J]. 国际护理学杂志,2022,41(19):3586-3590. DOI:10.3760/cma.j.cn221370-20210305-00911.

[25] 米嘉润,杜昕昱,李明坤,等. 我国三级公立医院住院患者对医生的信任现状及影响因素研究[J]. 中国医院管理,2024,44(8):17-22.

[26] 罗晓兰,李明. 医患沟通对患者依从性的影响机制探索[J]. 医学信息学杂志,2024,45(4):31-37. DOI:10.3969/j.issn.1673-6036.2024.04.006.

[27] 缪建辉,游翠芳. 线上线下结合的药学服务对老年糖尿病患者依从性及血糖水平的改善作用[J]. 中国老年学杂志,2023,43(23):5655-5657. DOI:10.3969/j.issn.1005-9202.2023.23.007.

[28] 汪永梅,陈冰汝,刘惠仙,等. 互联网线上随访模式在早产儿出院后随访中的应用效果[J]. 护理管理杂志,2024,24(3):272-276. DOI:10.3969/j.issn.1671-315x.2024.03.018.