항응고요법 환자의 약물지식과 환자역할행위와의 관계

Abstract

[한글]임상에서 가장 많이 쓰이는 항응고제는 코마딘 혹은 왈파로 이 약물은 다른 약물이나 음식에 의해서도 그 효능이 영향을 받기 때문에 이를 복용하는 대상자들이 약물관련지식이 있어야 치료의 효과를 높이수 있고 항응고요법과 관련된 환자역할이행을 잘 할 수 있다. 따라서 본 연구는 항응고제 복용환자의 약물지식과 환자역할행위 이행간의 관계를 파악하여 항응고제 복용 환자관리를 위한 기초자료를 제공하고자 시도되었다.연구대상은 서울시내 3차 종합병원 심장내.외과에서 항응고요법을 시작한지 6개월 이상 경과한 20세 이상의 외래환자를 선정하여 연구의 목적을 이해하고 참여를 허락한 사람으로 항응고제에 대한 교육을 받은 경험이 있는 150명을 대상으로 하였다.본 연구의 도구는 구조화돤 설문지를 사용하였다. 약물지식측정 도구는 약물지식에 대한 지식정도를 측정하기 위해 본 연구자가 개발한 총 13문항 으로 구성된 도구를 사용하였다. 환자역할행위 측정도구는 김영옥(1996)이 개발한 도구와 구미옥(1992)의 자가간호측정도구, 최정심(1984)의 치료지시 이행 측정 도구를 수정․보완한 것으로 17문항으로 구성된 도구를 사용하였다. 자료수집 기간은 2006년 10월 1일에서 30일까지 였으며 연구자와 훈련된 조사요원이 외래에서 대상자를 만나 자료수집을 하였다.자료분석의 경우 일반적 특성은 빈도와 백분율을 산출하였고, 대상자의 약물지식과 환자역할행위는 평균과 표준편차를 산출 하였다. 일반적 특성과 약물지식 및 환자역할행위와의 관계는 t-test 분산분석과 ANOVA로 분석하였고 약물지식과 환자역할행위와의 관계는 피어슨적률 상관계수로 분석하였다.연구결과는 다음과 같았다.1.대상자는 여자가 남자보다 많았고 약물복용 기간은 평균 약 90개월이었으며 대상자의 88.8%가 약물부작용으로 입원한 적이 없었고 항응고제 약물에 관한 설명을 주치의를 통해 들은 대상자가 75.3%를 차지했다. 약물에 대한 교육을 원하는 경우가 60.2%이고 교육방법은 책자를 선호하였며 자신의 혈액응고 수치를 기억하지 못하는 대상자가 80% 이였다.2.항응고요법환자의 약물지식은 13점 만점에 평균 8.13점으로 지식정도가 높게 나왔다. 영역별로는 약물복용 목적영역과 약물복용 부작용영역에서의 약물지식은 높았으나 식이영역과 병용약물 복용영역의 약물지식은 낮았다.3.항응고요법환자의 환자역할행위 이행은 68점 만점에 평균 60.64점으로 환자역할행위 이행이 높았다. 영역별로는 약물복용 및 관리영역과 건강습관영역, 약물복용 시 주의점 영역에서는 환자역할행위 이행이 높았으나 기호식품 섭취영역에서의 환자역할행위 이행은 보통이었다.4.항응고제 복용환자의 일반적 특성과 약물지식과의 관계에서 여자가 남자보다, 약물교육을 원하지 않는 사람이 원하는 사람보다, 혈액응고 수치를 기억하는 사람이 기억하지 못하는 사람보다 약물지식이 높았다.5.항응고제 복용환자의 일반적 특성과 환자역할행위 이행과의 관계에서는 여자가 남자보다, 약물교육을 원하지 않는 사람이 약물교육을 원하는 사람보다 환자역할행위 이행을 잘 하였다.6.항응고요법 환자의 약물지식이 높을수록 환자역할행위 이행을 잘하는 것으로 나타났다.결론적으로 항응고요법 환자들의 약물에 대한 지식이 높을수록 환자역할 행위도 높았다. 따라서 항응고요법 환자의 환자역할 행위를 높이기 위해서 약물지식을 높여야 하겠다. 이를 위해 식이와 병용약물에 관한 약물지식을 높이는 것과 환자역할행위를 높이기 위해서 약물복용시 주의점과 기호식품 섭취영역에 대한 구체적인 지식을 제공해야 한다. 이때 남자들의 약물지식과 환자역할행위를 높이기 위한 방안과 함께 항응고요법 환자들이 65세이상의 노인환자가 대부분을 차지하므로 이들 노인환자들을 고려한 교육방법이 개발되어야 할 것이다.

[영문]Inasmuch as such an anticoagulant as coumadine or warfar that is frequently used for clinical purposes, is seriously affected, particularly in terms of its efficiency, by other medicinal substances, foods or drinks, those who are administered with it can only obtain better therapeutical effects and are able to play better sick role behavior when they are equipped with its drug- related knowledge. With this in view, this study was prosecuted out of the motivation to elucidate the relationships between the drug-related knowledge and sick role behavior of those patients under anticoagulant therapy and then to provide fundamental data needed for the management of those patients.Subjects of this study were sampled out from outpatients over twenty years of age who had been under anticoagulant therapy for over six months at one of the third general hospital heart internal medicines or cardio-surgeries with a full understanding of the objective of this study as well as with the willingness to take part in the prosecution of this study. Among them 150 patients who had received education of the anticoagulant were taken as subjects of this study.The tool of this study utilized a structured questionnaire program. The tool to measure drug- related knowledge had recourse to a thirteen-item measurement scale developed by the writer of this study to see how much drug-related knowledge the subjects had. The tools to measure sick role behaviour of patients employed the patient role behaviour scale (1996) developed by Kim Young-ok, the self-care measurement scale (1992) created by Ku Mi-ok, and an adapted, corrected, and complemented version of the seventeen-item patient sick role behaviour measurement scale devised by Choi Jeong-sim. The duration of data collection ranged from October 1. 2006 to the 30th of the same month. And data collection was carried out by directly interviewing with outpatients by the writer of this study and her research aides.Data analysis included in itself the calculation of frequency and percentage on each of general characteristics and drug-related knowledge and sick role behaviour of patients, computed their mean scores and standard deviations. The determination of the relationships between the subjects' drug-related knowledge and sick role behavior depended upon t-test analysis of variance and ANOVA, while the relationships between drug-related knowledge and sick role behavior of patients were analysed with Pearson moment product coefficients. Study results were revealed as follows:1.The number of subjects showed a larger value in women than in men. The duration of medicinal administration averages approximately ninety months and 88.8 percent of them got once hospitalized due to an adverse reaction of medicine. The number of subjects who had heard explanation of the anticoagulant medicine from their physician in charge occupies 75.3 percent. Of them 60.2 percent wanted to receive education of drug-related knowledge, their method of learning had a preference for the use of books. On the other hand, the number of subjects who did not remember their blood coagulation value formed 80 percent.2.Drug-related knowledge of patients under anticoagulant therapy showed a high level of knowledge with a mean score of 8.13 points out of possible 13. When viewed in terms of different domains, drug-related knowledge indicated a high level both in the purpose of medicine administration and in its adverse reaction, while it pointed out a low level both in diet and in combined administration with medicine.3.Sick role behaviour of patients under anticoagulant therapy showed a high value with a mean of 60.64 on the basis of 68 points. When seen in terms of different domains, such domains as the management of medicine administration, health habit, and instructions for medicine administration indicated a high level of sick role behaviour, whereas favourite food intake an average level.4.As for the relationship between the general characteristics of patients under anticoagulant therapy and drug-related knowledge, a higher value was identified of drug-related knowledge in women than in men, in those patients who did not want to receive education of medicine administration than in those who did, and in those patients who had remembered their blood coagulation value than in those who had not.5.As regards the relationship between the general characteristics of patients under anticoagulant therapy and their sick role behavior, a higher level of sick rolebehaviour of patients was revealed in women than in men, and in those patients who had not wanted to obtain education than in those who had.6.The higher the level of anticoagulant-related knowledge they had, the higher level of sick role behavior they showed. In conclusion, the higher the level of drug-related knowledge those patients under anticoagulant therapy are equipped with, the higher level of sick role behavior they showed. Therefore, it is needed to enhance the level of drug-related knowledge in order to raise the standard of sick role behavior of patients under anticoagulant therapy. For that purpose, it would be a prerequisite to provide concrete knowledge of directions of medicine administration and favorite food intake so as to enhance the degree of the knowledge of related diet, combined administration of medicines, and sick role behaviour. As patients under anticoagulant therapy consist for the most part of those aged ones over sixty five years of age, we are in need of developing such education programs as can take into account those patients who are far advanced in years, along with formulation of strategies for elevating the level of drug-related knowledge, especially in men and the standard of sick role behavior of patients under anticoagulant therapy.