高齢者の服薬アドヒアランス評価ツールにおける因子間の構造モデルの検討

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The aim of this study was to generate a structural model among factors in a medicationadherence assessment tool for older adults, and to obtain guidelines regarding the potential application of this assessment tool. Data were collected from nurses who worked at acute-care hospitals and homevisit nursing stations nationwide. Of the 737 responses that were collected, and a hypothetical structural model encompassing six factors was tested via a path analysis. The hypothesized model used [medication behavior and stable life-style], [inhibitors of medication self-management], and [capability of medication record management] as predictor variables as well as [active participation in their treatment] and [stable medication compliance] as intervening variables. Although the goodness-of-fit indices were low, they were within the acceptable range of explanatory power. For a potential application of this assessment tool, priority should be given to assistance aimed at compensating for deficiencies in the three factors that constitute the foundation of medication self-management: that is, [medication behavior and stable life-style], [inhibitors of medication self-management], and [capability of medication record management]. Finally, it was proposed that support focusing on the content of the [stable medication compliance] and [active participation in their treatment] factors may lead to the improvement of the [health control ability with continuous medication] parameter.

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本研究は、高齢者の服薬アドヒアランス評価ツールにおける因子間構造モデルを検討 し、評価ツールの活用可能性について示唆を得ることを目的とした。急性期病院、訪問看護ステー ションの臨床経験３年以上の看護師を対象に質問紙調査を行った。回収部数737 部のうち545 部 を有効回答として評価ツール６因子間の仮説構造モデルの検証を行った。【服薬の所作と生活の 安定性】、【服薬自己管理の前提要件】、【服薬記録の管理】を予測変数、【積極的な治療参画】と【確 実な服薬行動】を介在変数、【継続的な服薬コントロール】を説明変数とする仮説モデルは、適 合度指標はやや低いものの、説明力としては許容範囲内であった。活用可能性として、予測変数 となる３因子は早期・優先的に支援し、次いで【確実な服薬行動】と【積極的な治療参画】を支 援することで、アウトカム向上につながる可能性が示唆された。