摘    要目的：调查杭州市社区老年人药物治疗依从性现状，剖析影响社区老年人药物治疗依从性的主要阻碍因素，为今后开展社区老年人健康教育与指导提供积极有效的对策与建议。方法：采用自行设计的调查问卷，对杭州市4个社区212名老年人进行调查。对分类变量采取频数和构成比描述，对符合正态分布的连续性变量采取平均值及标准差进行描述；采用单因素分析不同人口学特征及外部因素下，老年人药物治疗依从性分布的差异；运用Pearson相关分析医疗团队相关因素、自我护理能力、社会经济因素、疾病相关因素以及治疗相关因素这五个维度影响因素之间的相关程度；通过多重线性回归分析方法分析影响社区老年人药物治疗依从性的主要因素；运用结构方程模型分析影响社区老年人药物治疗依从性的直接因素、间接因素和潜在因素，检验各影响因素之间的因果关系。结果:本次调查共发放问卷212份，回收有效问卷205份，有效回收率为97%。1。信效度检验结果：与医护人员关系亲密程度量表的信度为Cronbach’s α=0。904，结构分析共提取2个公因子，共解释总方差的57。2%；自我护理能力调查量表的信度Cronbach’s α=0。840，结构分析共提取4个公因子，共解释总方差的51。8%；药物治疗坚持量表的信度为Cronbach’s α=0。650，结构分析共提取2个公因子，共解释总方差的53。5%。总体效度良好。2。杭州市社区老年人药物治疗依从性的五维因素与药物治疗依从性的关系：自我护理能力、社会经济因素、治疗相关因素与药物治疗依从性正相关（P<0。001）；医疗团队相关因素、疾病相关因素与药物治疗依从性负相关（P<0。001）。3。杭州市社区老年人药物治疗依从性的影响因素包括：治疗相关因素（标准系数=0。668, P<0。001）；疾病相关因素（标准系数= -0。532, P<0。001）；居住情况（标准系数=0。267, P<0。001）对老年人药物治疗依从性影响显著，与配偶、子女等一起居住的老年人的药物治疗依从性较好；文化程度（标准系数=0。246, P<0。001）在社会经济因素这一维度上对药物治疗依从性影响显著（P<0。05）。4。结构方程模型结果表明，拟合模型的Cmin/ DF=1。099，GFI=0。915，AGFI=0。902，RMSEA=0。054，拟合效果较好，该模型是个可以接受的模型。医疗团队相关因素（总效应值0。25，直接效应-0。72，间接效应值0。97）、自我护理能力（总效应值0。87，直接效应0。86，间接效应值0。01）、社会经济因素（总效应值0。88，直接效应0。58，间接效应值0。30）、疾病相关因素（总效应值-0。53，直接效应-0。53）、治疗相关因素（总效应值0。67，直接效应0。67）均可直接或间接影响药物治疗依从性。其中，社会经济因素对药物治疗依从性的效应值最大。结论：杭州市社区老年人的药物治疗依从性情况不容乐观；通过结构方程模型分析，影响杭州市社区老年人药物治疗依从性的主要因素是：医疗团队相关因素、自我护理能力、社会经济因素、疾病相关因素和治疗相关因素；并且显示这些影响因素对药物治疗依从性的直接效应和间接效应，最终模型拟合较好。建议建立良好的医患关系、增强老年人的自我护理能力、避免使用昂贵药物，减轻患者经济负担、建立药物治疗依从性监测系统。89829

毕业论文关键词：老年人；药物治疗依从性；影响因素

Abstract Objective: To investigate the current status of drug treatment compliance of the community elderly in Hangzhou, to analyze the main obstructive factors influencing the compliance of drug treatment, and provide some effective countermeasures or suggestions not only for the future health education, but also to guide the old people in the community。 Methods: The self-designed questionnaire was used to investigate 212 old people in four communities in Hangzhou。 Using frequency and proportions to describe categorical variables; using mean and standard deviation to describe normal continuous variable; the single factor analysis were used to compare the elderly drug treatment compliance distribution with different demographic characteristics and external factors; Pearson correlation analysis was used to research the relationship between the Influencing factors; the main factors influencing the drug treatment compliance of the aged were analyzed by multiple linear regression。 Structural equation model was used to analyze the direct factors, indirect factors and potential factors influencing the adherence of drug treatment in the elderly, and examine the causal relationship between the influencing factors。 Results: A total of 212 questionnaires were distributed in this survey, and collected 205 valid questionnaires, the effective recovery rate was 97%。 1。 Reliability and validity test results: Cronbach’s α of the fear and professional help personnel intimacy scale was 0。904, and two common factors were extracted from the structural analysis。 The total variance was 57。2%, and the validity was well。 Cronbach’s α of the self-care ability survey scale was 0。840, structural analysis of a total of four common factors were extracted, a total of 51。8% of the total variance was explained, and the validity was well。 Similarly, Cronbach’s α of the drug treatment adherence scale was 0。650, and the two common factors were extracted from the structural analysis。 The total variance was 53。5%, and the validity was well。 2。 The five factors of drug compliance of the community elderly in Hangzhou : self-care ability, socioeconomic factors (education level, Monthly household income) and treatment-related factors were positively correlated with drug treatment compliance (P<0。001); medical team-related factors (relationship with health care workers) and disease-related factors were negatively correlated with drug treatment compliance (P<0。001)。 3。 Factors affecting the compliance of drug treatment of the community elderly in Hangzhou : treatment-related factors (standard coefficient =0。668 P<0。001); disease-related factors (standard coefficient =-0。532, P<0。001); living conditions (standard coefficient =0。267, P<0。001), living with the spouse, children and other living has a better drug treatment compliance; the degree of education (standard coefficient =0。246, P<0。001) has a significant effect on the compliance of drug treatment in the dimension of socioeconomic factors cultural level (P<0。05)。 4。 The structural equation model shows that the main factors influencing the compliance of drug treatment : in fitting model, Cmin/DF = 1。099, GFI=0。915, AGFI=0。902, RMSEA= 0。054, the fitting effect is well and the model is an acceptable model。 Medical team-related factors (total effect value 0。25, direct effect -0。72, indirect effect value 0。97), self-care ability (total effect value 0。87, direct effect 0。86, indirect effect value 0。01), socioeconomic factors (total effect value 0。88, direct effect 0。58, indirect effect value 0。30), disease-related factors (total effect value -0。53, direct effect -0。53), treatment-related factors (total effect value 0。67, direct effect 0。67) all could directly or indirectly affect the drug treatment compliance。 Thereinto, the socioeconomic factors have the greatest effect on drug treatment compliance。 Conclusions: The situation of community elderly drug treatment compliance is not optimistic。 Through the structural equation model analysis, the main factors influencing the compliance of drug treatment among the elderly in Hangzhou community are medical team related factors, self-care ability, socioeconomic factors, disease-related factors and treatment-related factors。 These influencing factors have direct influence and indirect influence on drug treatment compliance, and the final model is well fitted。 It is recommended to develop a full range of health education, establish good doctor-patient relationship, enhance self-care ability of the elderly, avoid the use of expensive drugs, reduce the economic burden of patients and establish drug treatment compliance monitoring system。