| Objective:To assess the quo of medication adherence and explore the influencing factors of medication adherence among elderly hypertensive patients of a certain division of the Xinjiang production and construction corps.Through these analyses to provide a basis for primary health care institutions to develop interventions to improve medication adherence in elderly patients with hypertension.Methods:Using typical sampling,3 urban communities and 2 surrounding communities in the Xinjiang production and construction corps were selected.Investigation was conducted from July 2019 to December 2019,and the self-made "Questionnaire on the Medical Behavior of Hypertension Patients Participating in Basic Medical Insurance" was used to investigate the patient’s medication adherence and the influencing factors of the patient’s level,interpersonal level,organizational level and policy level.A total of 955 elderly hypertensive patients were investigated.Chi-square test and multivariate logistic regression analysis were used to analyze the influencing factors of medication adherence.An interview was developed based on the social-ecological system theory.A combination of objective sampling and convenience sampling was used to select 21 elderly hypertensive patients who completed the questionnaire survey for in-depth interviews,and the interview texts were analyzed using the Colaizzi 7-step method to further supplement and interpret the results of the quantitative analysis.Result:1.This research involves 955 elderly hypertensive patients,with an average age of 75.4±6.1 years.Most of the patients were female(63.4%),lived in the surrounding communities(54.6%),had an education level of primary school or below(67.9%),were married and lived together(72.1%);The proportion of patients with regular exercise,regular blood pressure monitoring and regular physical examination were 82.8%,87.4%,84.5%,85.4% and 97.8%,respectively,but only 65.7% of the patients whose salt was controlled below 6g.In general,elderly hypertensive patients were able to maintain a healthy lifestyle,but were relatively poor at changing and adhering to their dietary habits;Most patients had a disease course of 10 years or more(81.0%),and had at least 2 or more diseases(59.9%),and very few patients were taking traditional Chinese medicine antihypertensive drugs(7.3%),most patients felt that the severity of the disease was mild discomfort or asymptomatic(83.0%),very few patients had anxiety and depression(4.1%),a small number of patients used outpatient(17.9%),emergency(5.4%)and inpatient services(20.7%)in the last year.In general,have a longer course of disease,the disease symptoms were controlled,and their psychological state was better.2.The mean score of the self-administered medication adherence scale for the 995 elderly hypertensive patients surveyed was 18.3±2.8,which was a high score.There were 658 patients with good medication adherence and the medication adherence rate was 66.1%.3.According to the social-ecological system theory model,Among the patient-level factors affecting medication adherence in elderly hypertensive patients: higher self-perceived disease severity(OR=3.818,95%CI:1.633-8.928),smoking(OR=1.545,95%CI:1.080-2.210),and higher perceived medication cost burden were barriers to adherence,and not taking traditional herbal antihypertensive medications(OR=0.531,95%CI:0.321-0.879),taking 2 or more antihypertensive drugs(OR=0.528,95%CI:0.398-0.700),perceived threat of disease,medication taking habits,medication literacy,and perceived efficacy of drugs were facilitators of medication adherence;Among the interpersonal factors: peer influence were barriers to adherence,family support and trust in doctors were facilitators of medication adherence;Among the organization-level factors: general satisfaction with the service of the designated medical institution(OR=1.540,95%CI:1.048-2.262)was a barrier to medication adherence,and standardized community hypertension management was a facilitator of medication adherence;Among the policy-level factors: drug benefit program in hypertension outpatient(OR=0.694,95%CI:0.512～0.942)was a facilitator of medication adherence.Conclusion:1.Medication adherence among elderly hypertensive patients in the survey area is good,but it can be further improved;2.The social-ecological system theory model has a good ability to explain the medication adherence of elderly hypertensive patients and its influencing factors,and the medication adherence of elderly hypertensive patients is influenced by a combination of factors at different social-ecological levels(patient,interpersonal,organizational,and policy levels).Interventions can be developed based on this theory to improve medication adherence in elderly hypertensive patients in the future. |
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