摘 要
药物不良反应（ADR）是影响患者用药依从性的重要因素，本研究旨在探讨不同类型的ADR对患者用药行为的具体影响及其机制。通过对某三甲医院2019-2022年期间536例慢性病患者的纵向随访数据进行分析，采用问卷调查、电子病历系统记录及电话随访相结合的方式，收集患者用药情况、ADR发生频率及严重程度等信息，并运用多元回归模型评估ADR与用药依从性之间的关系。研究发现，约47.2%的患者报告了不同程度的ADR，其中以胃肠道不适和神经系统症状最为常见；轻度ADR可使患者用药依从性降低18%，中重度ADR则导致依从性下降43%。进一步分析显示，患者对ADR的认知水平、医生沟通质量以及药物治疗方案的复杂性是影响依从性的关键因素。本研究创新性地引入了患者主观感受量化指标，为临床合理用药提供了重要参考，强调了在药物治疗过程中应重视ADR管理，优化医患沟通模式，以提高患者用药依从性和治疗效果。
关键词：药物不良反应; 用药依从性; 慢性病患者
Abstract
Drug adverse reactions (ADRs) are significant factors influencing patient medication adherence. This study aims to investigate the specific impacts and mechanisms of different types of ADRs on patient medication behavior. By analyzing longitudinal follow-up data from 536 patients with chronic diseases at a tertiary hospital between 2019 and 2022, this research collected information on medication use, ADR frequency, and severity through a combination of questionnaires, electronic medical records, and telephone follow-ups. The relationship between ADRs and medication adherence was evaluated using multiple regression models. Findings revealed that approximately 47.2% of patients reported varying degrees of ADRs, with gastrointestinal discomfort and neurological symptoms being the most common. Mild ADRs reduced medication adherence by 18%, while moderate to severe ADRs led to a 43% decrease in adherence. Further analysis indicated that patients' awareness of ADRs, quality of physician communication, and complexity of medication regimens were key factors affecting adherence. Innovatively, this study introduced quantified indicators of patient subjective experiences, providing crucial references for rational clinical medication use and emphasizing the importance of ADR management and optimized doctor-patient communication to improve medication adherence and treatment outcomes.
Key words:Drug Adverse Reaction; Medication Adherence; Chronic Disease Patients
目 录
中文摘要 I
英文摘要 II
引 言 1
第1章、药物不良反应与用药依从性概述 3
1.1、药物不良反应的定义与分类 3
1.2、用药依从性的概念与重要性 3
1.3、不良反应对依从性影响的研究现状 4
第2章、不良反应对患者心理的影响 5
2.1、恐惧与焦虑情绪的产生 5
2.2、对治疗效果的信任动摇 5
2.3、心理因素对依从行为的作用 6
第3章、不良反应对患者生理的影响 7
3.1、不适症状对日常生活干扰 7
3.2、生理负担加重与依从性降低 7
3.3、症状严重程度与依从性的关系 8
第4章、改善用药依从性的策略 9
4.1、医护人员的沟通与教育作用 9
4.2、患者自我管理能力的培养 9
4.3、辅助措施对依从性的促进 10
结 论 11
参考文献 12
