数字技术管理下老年结核病患者服药依从性现状及影响因素探讨

doi:10.19982/j.issn.1000-6621.20250405

摘要/Abstract

摘要：

目的: 探讨基于数字技术管理的老年结核病患者的服药依从性现状及影响因素。方法: 采用便利抽样法,选取2024年8月至2025年8月在杭州市红十字会医院结核病诊疗中心住院且出院后接受数字技术对服药依从性管理的老年结核病患者220例作为调查对象。收集患者的一般人口学资料及疾病相关资料,通过问卷调查服药依从性、日常生活能力、家庭支持,采用单因素分析、二元logistic回归分析探讨各变量对服药依从性的影响。结果: 最终纳入205例老年结核病患者,服药依从组139例(67.8%),服药不依从组66例(32.2%)。多因素logistic回归分析结果显示,抗结核药物引起皮肤过敏反应(OR=16.357,95%CI:1.683~158.968)、抗结核药物引起的胃肠道反应(OR=3.804,95%CI:1.318~10.978)、其他药物过敏史(OR=10.782,95%CI:1.714~67.828)、数字技术随访应答良好(OR=0.317,95%CI:0.128~0.79),以及高家庭支持水平(OR=0.085,95%CI:0.017~0.414)、日常生活能力轻度依赖(OR=0.083,95%CI:0.008~0.901)和日常生活能力不依赖(OR=0.029,95%CI:0.001~0.675)是影响基于数字技术管理的老年结核病患者服药依从性的独立影响因素。结论: 基于数字技术管理的老年结核病患者服药依从性受抗结核药物所致的皮肤过敏反应、胃肠道不良反应、其他药物过敏史、数字技术随访应答、日常生活能力及家庭支持水平的影响,护理人员应针对影响因素实施个体化干预,以提升数字健康管理模式下的服药依从性。

关键词: 数字依从性技术, 结核, 服药依从性, 影响因素

Abstract:

Objective: To explore the status and influencing factors of medication adherence in elderly patients with tuberculosis based on digital technology management. Methods: With the convenience sampling method, 220 elderly tuberculosis patients who were hospitalized at the Tuberculosis Diagnosis and Treatment Center of Hangzhou Red Cross Hospital from August 2024 to August 2025 and who received digital technology for medication adherence management after discharge were selected as the study participants. Data on demographic characteristics and disease-related variables were collected through medical record review. Medication adherence, activities of daily living, and family support were assessed via structured questionnaires. Univariate analysis and binary logistic regression were performed to explore the associations between these variables and medication adherence. Results: A total of 205 elderly tuberculosis patients were included, with 139 (67.8%) in the medication compliance group and 66 (32.2%) in the medication non-compliance group. Multivariate logistic analysis showed that skin allergic reactions caused by anti-tuberculosis drugs (OR=16.357, 95%CI:1.683-158.968), gastrointestinal adverse reactions induced by anti-tuberculosis drugs (OR=3.804, 95%CI:1.318-10.978), history of allergy to other medications (OR=10.782, 95%CI:1.714-67.828), good follow-up response to digital technology (OR=0.317, 95%CI:0.128-0.790), high family support (OR=0.085, 95%CI:0.017-0.414), mild dependence on activities of daily living (OR=0.083, 95%CI:0.008-0.901), and non-dependence on activities of daily living (OR=0.029, 95%CI:0.001-0.675) were independent factors associated with medication adherence among elderly tuberculosis patients managed via digital technology (P<0.05). Conclusion: The medication adherence of elderly patients with tuberculosis based on digital technology management is affected by the skin allergic reactions and gastrointestinal adverse reactions caused by anti-tuberculosis drugs, history of allergy to other medications, follow-up response to digital technology, daily living ability and family support level. The nursing staff should implement tailored interventions based on the influencing factors to improve the medication adherence under the digital health management model.

Key words: Digital adherence technology, Tuberculosis, Medication compliance, Influencing factors

中图分类号:

张玥, 黄金鹏, 高丹, 凌琳. 数字技术管理下老年结核病患者服药依从性现状及影响因素探讨[J]. 中国防痨杂志, 2026, 48(6): 813-820. doi: 10.19982/j.issn.1000-6621.20250405

Zhang Yue, Huang Jinpeng, Gao Dan, Ling Lin. Status and influencing factors of medication adherence among elderly tuberculosis patients based on digital technologies[J]. Chinese Journal of Antituberculosis, 2026, 48(6): 813-820. doi: 10.19982/j.issn.1000-6621.20250405

图/表 3

表1

老年结核病患者服药依从性影响因素单因素分析

项目		服药依从组(139例)	服药不依从组(66例)		统计检验值	P值
性别					χ²=0.621	0.431
男性		88(63.3)	38(57.6)
女性		51(36.7)	28(42.4)
医保类别					χ²=4.942	0.084
医保		82(59.0)	38(57.6)
农保		50(36.0)	19(28.8)
自费		7(5.0)	9(13.6)
文化程度					χ²=4.098	0.129
初中及以下		78(56.1)	45(68.2)
中专及高中		31(22.3)	14(21.2)
大专及以上		30(21.6)	7(10.6)
吸烟				χ²=4.709		0.030
否	125(89.9)		52(78.8)
是	14(10.1)		14(21.2)
饮酒				χ²=4.001		0.045
否	124(89.2)		52(78.8)
是	15(10.8)		14(21.2)
婚姻状态				χ²=0.984		0.321
有配偶	102(73.4)		44(66.7)
无配偶	37(26.6)		22(33.3)
并发高血压				χ²=0.739		0.390
否	111(79.9)		56(84.8)
是	28(20.1)		10(15.2)
并发糖尿病				χ²=0.184		0.668
否	121(87.1)		56(84.8)
是	18(12.9)		10(15.2)
血型				χ²=5.035		0.169
A	47(33.8)		13(19.7)
B	22(15.8)		16(24.2)
AB	53(38.1)		28(42.4)
O	17(12.2)		9(13.6)
治疗分类				χ²=1.985		0.159
初治	127(91.4)		56(84.8)
复治	12(8.6)		10(15.2)
诊断分类				χ²=1.048		0.306
肺结核	78(56.1)		32(48.5)
肺外结核	61(43.9)		34(51.5)
其他药物过敏史				χ²=23.639		<0.001
否	136(97.8)		51(77.3)
是	3(2.2)		15(22.7)
皮肤过敏反应				χ²=6.987		0.008
否	137(98.6)		57(86.4)
是	2(1.4)		9(13.6)
胃肠道反应				χ²=5.504		0.019
否	126(90.6)		52(78.8)
是	13(9.4)		14(21.2)
数字技术随访应答				χ²=5.965		0.015
不佳	25(18.0)		22(33.3)
良好	114(82.0)		44(66.7)
家庭支持				χ²=7.504		0.023
低家庭支持	16(11.5)		13(19.7)
中家庭支持	84(60.4)		45(68.2)
高家庭支持	39(28.1)		8(12.1)
日常生活能力				-^a		<0.001
不依赖	1(0.7)		2(9.1)
轻度依赖	4(2.9)		14(31.8)
中度依赖	122(87.8)		49(57.6)
重度依赖	12(8.6)		1(1.5)
BMI[kg/m²,M(Q₁,Q₃)]	20.3(18.4,22.7)		20.1(17.6,22.1)	Z=-1.115		0.265
ALT[U/L,M(Q₁,Q₃)]	16(10,25)		16(10,29)	Z=-0.130		0.897
AST[U/L,M(Q₁,Q₃)]	19(16,28)		23(16,35)	Z=-1.168		0.243
BUN[mmol/L,M(Q₁,Q₃)]	4.6(3.5,5.9)		4.4(3.3,6.8)	Z=-0.219		0.826
SCr[umol/L,M(Q₁,Q₃)]	68.5(59.3,79.2)		66.9(54.5,79.9)	Z=-0.746		0.456

表1

表2

表3

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自变量	赋值方式
家庭支持	低家庭支持=(0,0);中家庭支持=(1,0);高家庭支持=(0,1)
日常生活能力	不依赖=(0,0,0);轻度依赖=(1,0,0);中度依赖=(0,1,0);重度依赖=(0,0,1)
吸烟	否=0;是=1
饮酒	否=0;是=1
皮肤过敏反应	否=0;是=1
胃肠道反应	否=0;是=1
其他药物过敏史	否=0;是=1
数字技术随访应答	不佳=0;良好=1

项目	β值	s${}_{\overline{x}}$值		P值		OR (95%CI)值
吸烟
否						1
是	0.224	0.751		0.766		1.251(0.287~5.456)
饮酒
否						1
是	-0.17	0.761		0.824		0.844(0.190~3.753)
皮肤过敏反应
否						1
是	2.795	1.160		0.016		16.357(1.683~158.968)
胃肠道反应
否						1
是	1.336	0.541		0.013		3.804(1.318~10.978)
其他药物过敏史
否							1
是	2.378		0.938		0.011		10.782(1.714~67.828)
数字技术随访应答
不佳							1
良好	-1.147		0.465		0.014		0.317(0.128~0.790)
家庭支持
低							1
中	-0.54		0.523		0.302		0.583(0.209~1.624)
高	-2.469		0.810		0.002		0.085(0.017~0.414)
日常生活能力
重度依赖							1
中度依赖	1.353		1.417		0.340		3.869(0.241~62.163)
轻度依赖	-2.485		1.215		0.041		0.083(0.008~0.901)
不依赖	-3.529		1.600		0.027		0.029(0.001~0.675)