류마티스관절염 환자의 약물 이행 영향요인

Abstract

Rheumatoid arthritis is a chronic disease that induces inflammation of all the joints in the body. It is important to increase medication adherence in order to improve the bodily functions in daily life by controlling the activation level of the disease and maintaining the joint functions. This study was carried out to provide basic data for development of nursing intervention in order to increase medication adherence of rheumatoid arthritis patients by assessing the factors that affect medication adherence of rheumatoid arthritis patients, and by assessing the effects that these factors have on perception of disease, emotional support, healthcare professional-patient relationship and medication adherence. This descriptive correlation study was conducted on patients diagnosed with and treated for rheumatoid arthritis at a university hospital situated in Seoul. 98 of a total of 100 copies of questionnaire retrieved with exclusion of 2 copies that were answered insincerely were analyzed. Questionnaire structuralized as a search tool was used with perception of disease, emotional support, healthcare professional-patient relationship and medication adherence measured by means of the Brief Illness Perception Questionnaire, Social Support Questionnaire Transaction, Client Satisfaction Tool and Compliance Questionnaire Rheumatology, respectively. Data were collected over the period of January 29, 2021 ~ March 5, 2021 and statistical analysis of the collected data was performed by using SAS Program, Ver. 9.4 (SAS Institute Inc., Cary, NC, USA). Results of this study are as follows: 1. A total of 98 subjects with 88 females (89.8%) and average age of 51.5±13.0 years in the range of 20~75 years were selected for this study. The largest number of subjects at 42 (42.9%) graduated from high school and 82.7% of the subjects lived with their family. 45 subjects (45.9%) were engaged in economic activities. Average duration of illness was 9.4±8.0 years with 14 rheumatoid arthritis patients in their initial stage with less than 2 years of duration of illness while 47 and 37 patients had duration of illness of 2~10 years and more than 10 years, respectively. 67 subjects had no side effects towards drugs administered for rheumatoid arthritis. 69 of the 98 subjects used biological agent and small molecule inhibitor, which are anti-rheumatic drug with 27 subjects (27.6%) with history of having changed the anti-rheumatic drug being administered within the last 6 months while 71 subjects (72.5%) have not. Average number of drugs being prescribed was 5.3±2.1 and average number of drugs being administered everyday was 4.1±2.1. The average value of DAS28, that is DAS28-ESR, used to objectively evaluate the extent of progress of rheumatoid arthritis was 3.5±1.5. 2. Although the average score for perception of disease was 22.8±4.7 in the range of the total score of 0~40 and that of emotional support was 56.3±10.9 (18~72), thereby displaying mid-range scores, and the average score for healthcare professional-patient relationship was high at 29.5±4.6 (7~35), there was no statistically significant correlation with medication adherence. 3. It was found that factors that affect the medication adherence included cases of DAS 28-ESR score in the range of 2.6~3.1 in comparison to 2.6 (OR 7.034, 95% CI 1.066-46.416, P=.018), daily number of drug administrations (OR 4.104, 95% CI 1.129-14.916 P=.032) and having used anti-rheumatoid arthritis drugs (OR 0.166, 95% CI 0.033-0.848 P=.031). Based on the above results, it was discerned that education on drug is necessary from the initial stage of the disease in order to increase the medication adherence of rheumatoid arthritis patients. Moreover, development of nursing intervention to fortify drug education differentiated in accordance with the stages of progress of the disease along with the need for drug and activation level of disease illustrated in the results of this study Key words: Rheumatoid arthritis patient, perception of disease, emotional support, healthcare professional-patient relationship, medication adherence|류마티스관절염은 전신관절에 염증을 일으키는 만성질환으로, 질병의 활성도를 조절하고 관절 기능을 유지하여 일상생활에서 신체 기능을 향상시키기 위해 약물 이행을 높이는 것이 중요하다. 본 연구는 류마티스관절염 환자들의 약물 이행에 미치는 요인을 파악하고 질병지각, 정서적지지, 의료인과의 관계와 약물 이행에 미치는 영향을 파악하여, 류마티스관절염 환자의 약물 이행을 높이기 위한 간호중재 개발의 기초자료 제공을 위하여 시행되었다. 본 연구는 서술적 상관관계 연구로 서울시 소재 일 대학병원에서 류마티스관절염을 진단받고 치료받는 환자를 대상으로 하였다. 총 100부의 설문지 중 불성실한 답변이 있는 2부를 제외하고 98부를 분석하였다. 연구 도구로 구조화된 설문지를 사용하였고, 질병지각은 The Brief Illness Perception Questionnaire으로 정서적지지는 Social Support Questionnaire Transaction으로, 의료인과의 관계는 Client Satisfaction Tool로 약물이행은 Compliance Questionnaire Rheumatology로 측정하였다. 자료 수집은 2021년 1월 29일부터 3월 5일까지 이루어졌으며, 수집된 자료는 SAS 9.4 version(SAS Institute Inc., Cary, NC, USA)프로그램을 이용하여 통계 분석하였다.

본 연구의 결과는 다음과 같다.

1. 본 연구의 대상자는 총 98명으로 여자가 88명(89.8%)이었으며, 평균연령은 51.5±13.0세, 20세~75세의 분포에 있었다. 고등학교 졸업이 가장 많은 42명(42.9%)이었으며, 82.7%가 가족과 함께 거주하였고, 경제 활동을 하는 경우가 45명(45.9%)이었다. 평균 질병 유병 기간은 9.4±8.0년으로 2년 이하의 초기 류마티스관절염 환자는 14명, 2년~10년 미만은 47명, 10년 이상은 37명이였으며, 류마티스 약물에 대한 부작용은 없는 경우가 67명이었다. 대상자 98명 중 69명은 항류마티스약제인 생물학적제제와 소분자억제제를 사용하였으며, 6개월 이내에 항류마티스약제를 변경한 경우가 27명(27.6%), 변경하지 않은 경우가 71명(72.5%)이었다. 전체 처방한 약의 개수는 평균 5.3±2.1개였고, 매일 복용하는 약물의 개수는 4.1±2.1였다. 류마티스관절염에서 질병이 활발하게 진행하는 정도를 객관적으로 평가하는 수치인 DAS28의 수치는 DAS28-ESR는 평균 3.5±1.5이었다.

2. 대상자의 질병지각은 총점 0~40에서 22.8±4.7, 정서적지지는 56.3±10.9 (18~72)으로 중간 정도의 점수를 나타내었고, 의료인과의 관계는 29.5±4.6 (7~35)로 높은 점수를 나타내었지만 약물 이행과 통계적으로 유의한 상관관계를 보이지 않았다.

3. 약물 이행에 영향을 미치는 요인은 DAS 28-ESR 2.6 미만 대비 2.6~3.1인 경우(OR 7.034, 95% CI 1.066-46.416, P=.018), 일일 약 복용 횟수(OR 4.104, 95% CI 1.129-14.916 P=.032), 항류마티스 약제를 사용한 경우(OR 0.166, 95% CI 0.033-0.848 P=.031)로 나타났다.

이상의 결과로부터, 류마티스관절염 환자의 약물 이행을 높이기 위해 질병의 초기 단계부터 약물 교육이 필요하며, 연구결과로 나타난 약의 필요성과 질병 활성도와 같이 질병 과정에 따라 차별화된 약물 교육을 강화 할 수 있는 간호중재 개발이 필요하다.