乡镇卫生院老年高血压患者居家用药偏差现况及其影响因素研究

Current Status and Influencing Factors of Medication Deviation among Elderly Patients with Hypertension at Home in Township Hospitals

摘要: 目的：调查乡镇卫生院老年高血压患者居家用药偏差的现况，并分析其影响因素。方法：选取2024年1月至2025年6月南阳市宛城区茶庵乡卫生院管理的574例老年原发性高血压患者为研究对象。采用患者社会人口学资料、用药相关资料、疾病相关资料、量表评估及用药偏差评估资料进行调查。采用单因素分析及多因素Logistic回归分析用药偏差的影响因素。结果：574例患者中，278例存在用药偏差，总体发生率为48.43%。最常见的偏差类型为时间错误(22.57%)和药物遗漏(21.12%)。多因素Logistic回归分析显示，年龄 ≥ 80岁(OR = 2.614)、独居(OR = 2.325)、药物知识完全不了解(OR = 3.021)、长期服用药物 ≥ 5种(OR = 2.175)、有药物不良反应(OR = 1.715)、高血压自我管理低水平(OR = 2.426)及服药依从性不佳(OR = 2.046)与用药偏差存在独立关联(均P < 0.05)。结论：乡镇卫生院老年高血压患者居家用药偏差发生率较高，偏差形式多样。高龄、独居、用药复杂、自我管理水平低及依从性不佳等因素与用药偏差存在独立关联，应重点关注具备这些特征的患者，采取针对性干预措施以保障居家用药安全。

Abstract: Objective: To investigate the current situation of medication deviation among elderly patients with hypertension in township health centers and analyze the influencing factors. Methods: A total of 574 elderly patients with primary hypertension managed by the Cha’an Township Health Center in Wan Cheng District, Nanyang City from January 2024 to June 2025 were selected as the research subjects. The patients’ sociodemographic data, medication-related data, disease-related data, scale assessment, and medication deviation assessment data were investigated. Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of medication deviation. Results: Among the 574 patients, 278 cases had medication deviation, and the overall incidence was 48.43%. The most common types of bias were time error (22.57%) and medication omission (21.12%). Multivariate Logistic regression analysis showed that, Age ≥ 80 years old (OR = 2.614), living alone (OR = 2.325), no understanding of drug knowledge (OR = 3.021), long-term use of ≥ 5 drugs (OR = 2.175), adverse drug reactions (OR = 1.715), low level of hypertension self-management (OR = 2.426) and poor medication compliance (OR = 2.046) were independently associated with medication deviation (all P < 0.05). Conclusion: The incidence of medication deviation in elderly patients with hypertension at home in township hospitals is high, and the forms of medication deviation are diverse. Factors such as old age, living alone, complicated medication, low self-management level and poor compliance are independently associated with medication deviation. We should focus on patients with these characteristics, and take targeted intervention measures to ensure the safety of home medication.