일 대학병원 정신과 외래 환자의 약물 순응도에 영향을 미치는 요인

Predicting Factors Associated with Drug Compliance in Psychiatric Outpatients of a University Hospital

정신과 환자에서 약물치료에 대한 순응도는 질환의 경과 및 예후와 밀접하게 관련된다. 이에 본 연구에서는 대학병원 정신과 외래 환자를 대상으로 약물 순응도를 조사하고 이에 영향을 미치는 요소를 파악하고자 계획하였다. 연구방법은 자가 보고식 응답에 의하여 약물 순응군과 약물 비순응군으로 구분한 후 각각의 그룹에 대해 연령, 성별 등의 사회인구학적 변인과 정신과적 진단명, 신체적 질환 여부, 임상변인을 비교 하였다. 결과로는 약물 및 부작용에 대한 설명과 이에 대한 만족도, 정신과 약물에 대한 주관적, 부정적 태도 만이 약물 순응도에 영향을 주는 것으로 나타났다. 따라서 환자 개인이 가지고 있던 정신과적 약물치료에 대한 부정적 인식을 개선하는 것이 약물 순응도를 높이는데 효과적일 것으로 예상할 수 있다.

Objective　Drug compliance is closely related to progress and prognosis of psychiatric disease. We investigated drug compliance　in psychiatric outpatients and factors that influence their compliance. Methods　Patients who visited a university hospital were asked about drug information and drug compliance using questionnaires.　Medical records of the patients were reviewed. Demographic variables, clinical characteristics and drug compliance　related variables were compared between non-compliance group and compliance group. Logistic regression analysis　was performed to clarify predictors of poor compliance.　 Results　One hundred eighty one patients participate in this study. 150 patients (82.9%) were compliance group, 31 patients　(17.1%) were included in non-compliance group. Patient-related, illness-related and treatment-related factors, DAI total　score and knowledge of side effect did not show any difference in both groups. However, illness severity was relatively　higher in non-compliance group (p = 0.070) and patient’'s satisfaction about explanation of side effect was lower in noncompliance　group (p = 0.061). Moreover, patients who negatively answered for question about negative recognition to psychiatric　medication in DAI questionnaire were more common in non-compliance group (p = 0.075). In logistic regression,　answering negatively to question about negative recognition to psychiatric medication in DAI questionnaire was related to　non-compliance, but did not reached statistical significance (p = 0.086). Conclusion　This study suggests that improving negative recognition about psychiatric medication through drug education　and good doctor patient relationship could enhance drug compliance.