Measuring Medication Adherence And The Impact Of Factors In Patients With Coronary Heart Disease

Objective:Secondary prevention of the coronary heart disease is the basis for prevention and treatment of CHD, and the medication adherence is one of the main factors influencing treatment outcome.This paper discussed reliability and validity of the modified Morisky Medication Adherence Scal measuring patients with coronary heart disease;while understand whether there were differences in medication adherence for patients of different ages, gender, work, education, income, living, time and the number of stent implantation, cardiac function, comorbidities, etc.And looked for factors which influenced medication adherence, provided more targeted guidance and intervention for future treatment and rehabilitation of these patients.Methods:After the consent of the author and authorization, purchased and used translation version in Chinese and used the revised MMAS-8 to measure medication adherence in Chinese patients with coronary artery disease;selected the patients was diagnosed with coronary heart disease in the First Affiliated Hospital of Kunming Medical University, the questionnaire to patients and according to the secondary prevention drugs of coronary heart disease (including aspirin, clopidogrel, statins, beta blockers and ACEI/ARB drugs, etc.) to complete the revised MMAS-8 and the MA-VAS; also a random sample was selected from the 15% of respondents,2 weeks later pays a return visit by telephone, fill out the revised MMAS-8 again, to evaluate the retest reliability of the scale.Used SPSS20.0 software to analysis the reliability and validity of the revised MMAS-8.Used SAS9.3 software to analysis the influence factors of medication adherence.Results:200 questionnaires were issued to the patients which diagnosed with coronary heart disease,200 questionnaires were taken back,and eliminated the invalid questionnaire which one was incomplete,improper, not clear, obvious logical errors,at last a total of 191 valid questionnaires were selected, the effective rate was 95.5%.The statistics showed:1. Crobach a of the revised MMAS-8 was 0.717, ICC was 0.907. Extracted three common factors in structure analysis, explained 66.48% of total variance.The revised MMAS-8 score and the MA-VAS score was correlated (r=0. 786, P<0.001).2. The proportion of high, medium and low adherence rate was respectively 23.04%,43.98%,32.98%;Aspirin, clopidogrel, statins, beta blockers and ACEI/ARB adherence rate were 96.34%,67.02%,23.04%,56.54%,46.60%.3. Single factor analysis of the degree of medication adherence:numbers of comorbidities (x2=9.98, P=0.019), NYHA classification (x2=11.42, P=0.003),stenting time (x2=66.39, P=0.000), medication knowledge (x2=92.29, P=0.000), medication categories (x2=66.74, P=0.000), monthly costs (x2=64.83, P=0.000), monthly income (x2=20.81, P=0.000), living condition (x2=15.79, P=0.000) had a significant influence on different degree of medication adherence.4. On the basis of single factor analysis, the different degree of medication adherence as the dependent variable, social demographic data and clinical data as independent variables, for medication adherence multiariable logistic regression analysis, there were four variable such as the types of comorbidities, NYHA classification, stenting time, medication knowledge had an impact on medication adherence, including comorbidities [1、2 kinds of VS no comorbidity OR=0.204 (0.073-0.571)、0.235 (0.078-0.708)];NYHA classification levels [II VS I OR=0.275 (0.122-0.619)], stenting time [≤1 year VS 1-3 years OR=23.810 (5.107-111.016);> 3 years VS≤1 year OR=0.034 (0.010-0.115)]; medication knowledge [clearly VS probably、unclearly OR=11.322 (4.605-27.838)、>999.999 (167.526-999.999); probably VS unclearly OR=93.032 (18.985-455.888)].Conclusions:1.The revised MMAS-8 has good reliability and validity, and suitable for clinical to measure the medication adherence of patients with coronary heart disease; 2.1n patients with coronary heart disease, adherence medium account for the large proportion, medication adherence of patients to asprin well,while to stains poor; 3. The influence factors of CHD patients with medication adherence was complicated, the medication adherence of these patients was lower who combined with one or two kinds of disease relative to without comorbidity、NYHA for II level relative to the I level、stenting time> 3 years relative to ≤1 year; while the medication adherence of patients is higher whose stenting time ≤1 year relative to 1-3 years、 medication knowledge was clearly or probably relative to unclearly.