| Summary: | 碩士 === 國立中正大學 === 資訊管理系醫療資訊管理研究所 === 106 === Ankylosing spondylitis is a type of the autoimmune and chronic inflammatory disease that results in the adherence of spinal joints leading to joint pain and stiffness. Due to inflammation of tendon, ligament, and other soft tissue near spinal column, the spine will fused together and form ‘bamboo spine”. Currently, the main treatment for ankylosing spondylitis is medication. The target is to keep the disease under control so that patients can be able to maintain their daily functions. Therefore, medication adherence is an important issue for these patients. The purpose of this study was to explore the factors ssociated with medication non-adherence in patients with anskylosing spondylitis. A questionnaire survey was conducted at the rheumatology clinic of a regional teaching hospital in southern Taiwan from November 4, 2016 to January 24, 2017. The effective sample size was 206. Medication possession ratio (MPR) was used as index for assessing the level of medication adherence. Computerized medical records of the past two years were assessed for the data on the use of (1) non-steroid anti-inflammatory medicine, (2) biologics, and (3) both non-steroid anti-inflammatory medicine and biologics. MPR 80% was classified as medication adherence whereas a MPR < 80% was classified as medication non-adherence. Logistic regression analyses were used to analyze the association between the three dependent variables of medication non-adherence and demographics, health conditions, spine X-ray changes, severity levels of ankylosing spondylitis and quality of life. Result showed the MPR for ankylosing spondylitis patients using non-steroid anti-inflammatory medicine was 0.80, and was 0.78 for those using biologics. In addition, the MPR was 0.76 for patients using both non-steroid anti-inflammatory medicine and biologics. Multiple logistic regression analyses showed that (1) for patients using non-steroid anti-inflammatory medicine, patients with no regular exercises were significantly associated with a higher risk of medication non-adherence (odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.10–3.59, P = 0.023); (2) for patients using biologics, those with a body mass index categorized as obese, compared with those categorized as normal and underweight were significantly associated with a low risk of medication non-adherence (OR = 0.27, 95% CI = 0.08–0.97, P = 0.045); and (3) for patients using both non-steroid anti-inflammatory medicine and biologics, those without regular exercises were marginally associated with a higher risk of medication non-adherence (OR = 1.76, 95% CI = 1.10–3.11, P = 0.051). Conversely, spine X-ray changes, severity levels of ankylosing spondylitis, and quality of life were not significantly associated with medication non-adherence. In conclusion, findings from this study showed that the MPR of patients with ankylosing spondylitis patients did not fully acheive the ideal level of 0.80. It is suggested that nursing staff shoud reinforce the health education on medication adherence in patients who do not engage in regular exercises.
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