Survey of the Patients^|^apos; Consciousness Affecting Medication Adherence

Abstract

522 緒 言 患者が医師の処方した薬を指示通り服用するこ とは，薬物治療を行ううえで重要なことである． これは，医療者の指示に患者がどの程度従うかを 評価する「コンプライアンス」の考え方である． 2001 年に WHO（世界保健機構）が， 「コンプライ アンスではなくアドヒアランスという考え方を推 進する」という方向性を示した．これを契機に， 患者が積極的に治療方針の決定に参加し，その決 定に従って治療を受ける「アドヒアランス」の考 え方が主流になりつつある． 1） 従来から用いられ ている薬物療法におけるコンプライアンスは， ｢決められたとおりに患者が正しく服用すること｣ を意味し，医師や薬剤師の指示通りに服薬してい る場合に， 「服薬コンプライアンスが良い」と評 価される．このような， 服薬コンプライアンスは， 医師や薬剤師が患者に服薬を遵守させることか ら，医療者が主体である．これに対して，服薬ア ドヒアランスは，患者が薬の作用・副作用につい て十分な説明を受け納得したうえで，服薬意義を 理解し，主体的に治療を受け，継続した服薬を行 ＊ 岐阜県岐阜市大学西1-25-4 医療薬学 38(8) 522―533 (2012) An important aspect of medicinal treatment is having the patient take the medicines prescribed by the doctor. However, a previous questionnaire about medication compliance and adherence showed that approximately 50％ of patients forget to take their medicines. In this study, the status of patient medication-taking behavior and factors affecting adherence were investigated through a survey involving 226 patients who presented at Gifu Municipal Hospital from November 2009 to February 2010. The survey items included patient characteristics (age, sex, occupation, side effects, allergies, etc.), medication status (dosing time, medicine formulations), and factors affecting medication adherence (awareness of taking medication, awareness of illness and medicines, life rhythm, character, relationship of trust with doctor or pharmacist, use of medicine information leaflets). Overall, 73％ of patients took medicines as directed. Evaluation by medication adherence status revealed that patients with poor adherence most frequently forgot to take their medicines after lunch and between meals. A separate factor analysis of good and poor medication adherence groups showed significant differences between the groups for 18 of 30 factors. Then, using Customer Satisfaction analysis and excluding factors related to personality, 4 factors for improvement were selected from the remaining 16 factors. These findings suggest that patient medication adherence increases when the factors of " regularity of life rhythm " , " regularity of meals " , " trust in pharmacists " , and " use of medicine information leaflets " are improved.