肾移植受者应对方式对服药依从性及自我管理的影响

目的探讨肾移植受者疾病应对方式、服药依从性及其自我管理的特点，并分析应对方式对服药依从性和自我管理依从性的影响。 方法采用便利抽样选取2019年3月至5月广州医科大学附属第三医院器官移植随访门诊就诊的肾移植受者作为研究对象。采用一般情况调查表、医学应对问卷、免疫抑制剂依从性Basel评估量表(BAASIS)及肾移植受者自我管理调查量表作为调查工具。所有问卷调查均在肾移植受者门诊随访时进行。采用成组t检验比较肾移植组和慢病常模组面对、回避和屈服因子得分。应用分层回归方程分析肾移植受者应对方式对服药依从性和自我管理的影响。P<0.05为差异有统计学意义。 结果肾移植受者面对因子得分[(19.8±2.9)分]最高。肾移植组和慢病常模组回避因子得分分别为(15.1±2.7)和(14.4±3.0)分，差异有统计学意义(t＝-2.320，P<0.05)。肾移植受者BAASIS得分平均为(22.2±2.6)分，125例受者中53例(42.4%)受者服药依从性好。36例(28.8%)曾在过去1个月中至少漏服1次免疫抑制剂；19例(15.2%)在过去1个月中曾出现至少1次连续漏服状况；63例(50.4%)曾在过去1个月中提前或推迟2 h服药；9例(7.2%)曾不按医嘱剂量服药。肾移植受者自我管理总得分为(91±8)分，其中68例(54.4%)自我管理水平良好，57例(45.6%)自我管理处于中等水平。受者饮食、治疗、躯体活动和社会心理管理得分分别为(29.5±3.0)、(33.4±3.4)、(15.7±2.1)和(12.4±1.6)分。面对、回避和屈服3个变量分别解释服药依从性总变异的8.6%，治疗管理总变异的13.7%，躯体活动管理总变异的7.0%，社会心理管理总变异的25.0%，整体自我管理总变异的15.0%。服药依从性的预测因子为屈服(β＝-0.252，P<0.01)，饮食管理的预测因子为面对(β＝0.212，P<0.05)，治疗管理的预测因子为面对(β＝0.348，P<0.01)，躯体活动管理的预测因子为面对(β＝0.255，P<0.01)，社会心理管理的预测因子为面对和屈服(β＝0.394和-0.271，P均<0.01)，整体自我管理的预测因子为面对(β＝0.365，P<0.01)。 结论肾移植受者应对方式是服药依从性和自我管理的重要影响因素，应重视其对待疾病的态度和方式，及时转换其消极的应对策略，以提高其服药依从性和自我管理水平。

The impact of coping styles on medication adherence and self-management among kidney transplant recipients

ObjectiveTo investigate the coping styles, medication adherence and self-management of kidney transplant recipients, and to explore the predictive effects of coping styles on adherence to medication and self-management. MethodsConvenience sampling was used to recruit 125 kidney transplant recipients (kidney transplant patients group) at the clinic of the Third Affiliated Hospital of Guangzhou Medical University. All recipients completed general information sheet, medical coping modes questionnaire (MCMQ), basel assessment of adherence with immunosuppressive medication scale (BAASIS) and the kidney transplant recipients self-management scale. Data were collected during recipients′ follow-ups. Hierarchical regression was conducted to examine the predictive effects of coping styles on adherence to medication and self-management. Both variance inflation and tolerance values were examined for the possible presence of multicollinearity. A P value less than 0.05 was considered statistically significant. ResultsKidney transplant recipients scored highest in confrontation (19.8±2.9). Avoidance scores in kidney transplant patients group was (15.1±2.7) which was differed from the chronic disease norm group (14.4±3.0) (t=-2.320, P<0.05). Kidney transplant recipients scored (22.2±2.6) in BAASIS, 53 cases (42.4%) showed good medication adherence; 36 (27.9%) recipients had missed at least one dose of immunosuppressants in the past month; 19 recipients (15.2%) had at least one consecutively missed drugs in the past month; 63 recipients (50.4%) had taken drugs 2 hours earlier or later in the pat month; 9 recipients (7.2%) had not taken medicine according to doctor′s advice. The total score of self-management was (91±8), 68 (54.5%) recipients had good self-management and 57 (45.6%) recipients had moderate self-management. The scores of diet, treatment, physical activity and psychosocial management were (29.5±3.0), (33.4±3.4), (15.7±2.1) and (12.4±1.6), respectively. Coping styles variables, including confrontation, avoidance and resignation added 8.6% explained variances to medication adherence, 13.7% explained variances to treatment management, 7.0% explained variances to physical activity management, 25.0% explained variances to psychosocial management, and 15.0% explained variances to overall self-management, respectively. Hierarchical regression analyses suggested that resignation (β=-0.252, P<0.01) was significant predictor of medication adherence; confrontation was significant predictor for diet management (β=0.212, P<0.05), treatment management (β=0.348, P<0.01) , physical activity management (β=0.255, P<0.01) and the overall self-management (β=0.365, P<0.01); the significant predictors of psychosocial management were confrontation and resignation (β=0.394 and -0.271, P<0.01). ConclusionsThe coping styles of kidney transplant recipients had a significant influence on both adherence to medication and the self-management recommendations. In order to improve medication adherence and the level of self-management among kidney transplant recipients, health professions need to pay more attention to the coping strategies used and alter their negative copings timely.