심부전은 안정 시나 운동 시에 필요한 대사요구를 충족시킬 만큼 충분한 혈액을 심장이 펌프 할 수 없는 상태로 성인기 이후의 대상자들에게 있어 유병률 및 사망률을 증가시키는 주요 심장질환 중 하나이다(Kashani et al., 2004). 만성 심부전 환자들은 질병의 진행 정도에 따라 신체적으로 피로, 허약감, 호흡곤란, 전신부종 등을 경험하며 이로 인해 직장생활 및 사회활동의 참여는 물론 기본적인 일상생활을 수행하는 데에도 장애를 초래한다. 심리적으로도 불안이나 우울, 자존감 저하 등으로 본인뿐만 아니라 환자를 돌보는 가족의 삶의 질에도 많은 부정적인 영향을 미치게 된다(Clark et al., 2009; Riegel et al., 2009; Stewart, MacIntyre, Capewell, & McMurray, 2003). 또한 이러한 질병과정에서 발생하는 재입원이나 집중 치료 등은 환자 및 가족의 의료비 부담은 물론 전체 의료비의 상승을 초래하는 주요 원인이다(Van der Wal et al., 2006; Wu et al., 2008b).
Purpose: The purpose of this study was to explore socio-demographic, clinical and psychological factors associated with medication adherence among patients with chronic heart failure (CHF). Methods: In a cross-sectional survey, 133 patients with CHF who had visited a clinic located in Seoul participated. Medication adherence (MA) was measured using a single item visual analogue rating scale (VAS). Barriers and attitudes toward adherence, and depression were measured using a structured questionnaire. Medical records were reviewed to identify their clinical characteristics. Multivariate logistic regression was performed identify factors affecting medication adherence. Results: About one third of participants (31.1%) reported their MA as 100%. Overall attitudes on MA were highly positive and 49 (36.8%) of participants were depressive. MA was associated with significantly barriers (p<.001), attitudes (p<.001), age (p<.001), and duration of disease (p<.001). The high adherent group had significantly less barriers than other groups (OR=.389, p=0.02). Conclusion: This study indicates that barriers and attitudes toward MA were the most important factors affecting their adherence to HF medication. To improve MA for patient with CHF, the nursing strategies which can lead poor adherent patients to their optimal level should be developed.
서 론 연구 방법 연구 결과 논 의 결론 및 제언
