【作者】 胡银环；

【导师】 张亮；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2007， 博士

【摘要】 研究目的目前,越来越多的城市居民对于一些常见疾病和健康问题开展自我药疗。由于我国大多数城市居民的医药知识有限,不懂得药理作用和不良反应,不能正确理解和按照药品说明书用药,购药及用药行为还受到其它各种外部因素的影响,导致居民在自我药疗过程中存在大量的健康风险,严重者甚至危及生命,必须采取有效的干预措施尽可能规避这些风险,促进居民自我药疗的安全性和有效性。本研究正是试图从行为科学的角度出发,通过系统研究城市居民自我药疗行为的结构、特征、影响因素、健康风险及其关键影响因素,结合健康行为学、消费者行为学、健康促进的有关理论与方法,从行为改变的角度探讨防范城市居民自我药疗健康风险的行为干预策略,既为政府的有关决策提供依据,又为居民自我药疗行为干预提供理论指导,有效促进居民自我药疗的安全性和有效性,提高居民健康水平。研究方法本研究采取定量研究和定性分析相结合,文献资料来源于期刊论文、专著、文件汇编、常规统计资料等。问卷调查以武汉市为研究现场,以18岁及以上曾经有过自我药疗行为的城市居民为研究对象,采取分层随机抽样的方法,共抽取6个社区和4个药店,由经过培训的调查员对社区居民和药店购药居民进行询问调查,回收有效问卷656份。采用Epidata3.0软件建库录入数据,SPSS12.0统计软件进行统计分析,运用了描述性分析、χ2检验、多元Logistic回归分析等方法。定性资料来源于对城市自我药疗居民的行为观察和对药店工作人员、药师的深入访谈。研究结果1.居民自我诊断时最主要的依据是个人经验(66.2%),其次是咨询药店工作人员(14.8%)和药品说明书(6.3%)。低受教育程度的人、老年人更多的依据个人经验进行自我诊断,年轻人更多的依据药店工作人员和药品广告进行自我诊断,受教育程度高的人更多依据书籍杂志网络进行自我诊断;有83.8%居民购药时经常看药品生产日期与有效期,老年人、低受教育程度的人购药时不爱看生产日期与有效期,不注意看药品有无说明书,购药遇到问题时不愿意咨询药师和店员;年轻人、受教育程度高的人购药更易受店员推荐和药店促销活动影响;87.5%的居民用药前经常阅读说明书,但只有30.1%的居民能完全明白说明书的内容,老年人、受教育程度低的人用药前不爱阅读药品说明书,不爱读药品说明书上的不良反应、禁忌及注意事项,不易读懂药品说明书;有71.8%的人根据药品说明书确定用法、用量和疗程,13.7%的居民服药方法错误,18-44岁居民、男性居民服药方式错误率较高。大部分人(65.2%)自觉病情好转后就停药,还有一部分人(17.7%)自觉病愈后再加服一段时间才停药;受教育程度低的居民贮存药品时较不注意其贮存条件。2.高受教育程度居民自我药疗知识的知晓率明显高于低受教育程度居民,居民的自我药疗知识与其自我药疗行为有一定的相关性,掌握自我药疗知识较好的高分组有较好的自我药疗行为,其自我药疗的风险性较低;自我效能低、自信心差是自我药疗行为健康风险的危险因素,服药方式知识正确是自我药疗行为健康风险的保护性因素;居民的医疗保障情况与其购药是否选择医保定点药店有关联,购药可以报销的居民更倾向于选择医保定点药店购药。3.有52.9%的人用药时频繁更换药物,57.0%的人用药时随意增减用药疗程,55.2%的人用药时随意增减用药剂量,年轻人、受教育程度高的人用药时更易频繁更换药物,更易随意增减用药疗程;有30.2%的人自我诊断出现过失误,15.6%的人因药品广告的误导而选择了不对症药品,年轻人、男性更易受药品广告的影响而选购不对症药品;有11.7%的人因误解药品说明书的内容而导致用药错误,有26.8%的人自我药疗时曾经同时服用多种相同适应症药物,23. 8%的人曾经同药不同名而同时使用,高受教育程度、年轻人、男性居民更易同时服用多种相同适应症药物;有19.7%的人经常使用解热镇痛药,42.4%的人经常使用抗生素;有13.3%的人由于没有注意药品说明书上的禁忌症而产生药物误用,16.0%的人服药期间从来不注意饮食禁忌,尤其是年轻人;35. 7%的人用药时从不考虑个体的生理特质,特别是低受教育程度的人;有37.2%的人在自我药疗过程中出现过除药物本身副作用以外的药物健康损害,老年人自我药疗更容易发生药物健康损害。4.多元Logistic回归分析结果显示,自我诊断错误频率低是自我药疗行为健康风险的保护性因素,而无处方购买到处方药、同药不同名而同时使用是自我药疗行为健康风险的危险因素。结论与建议综合本研究结果提出以下自我药疗行为干预建议:1.加强居民自我药疗知识教育;2.实施行为的自我管理,塑造居民低风险自我药疗行为;3.加强药店处方药销售管理,推广实施《优良药店工作规范》;4.充分发挥药店执业药师药学服务功能,为购药居民建立药历;5.加强药品广告监管,由政府发布权威药品信息;6.规范药品说明书格式与内容,倡导说明书的正确使用。更多还原

【Abstract】 ObjectivesMore and more citizens self-medicate for their minor ailments at present, however, there are many health risks in their self-medication, for they are ignorant of pharmacodynamics and the adverse drug reaction with limited drug knowledge, and they can not understand drug use instructions rightly and use dugs according to it during self-medication.Hence, intervention measures must be carried out to reduce the health risks. The study is ready to investigate the characteristics、structure、influencing factors and health risks of the self-medication behavior of the citizens from the view of behavior science and discuss the behavior intervention strategies of self-medication with the theories and methods of health promotion. It can give policy referrence for the government and theory guidance for the intervention which is importance for the citizens to use drug rationally.MethodsThe study applied quantitive and qualitative methods, the literature data derived from the periodical discourse、the monograph、the collection of polices and regular health register.The questionnaire survey selected Wuhan city as the field and the citizens who had self-medicated for the ailments over 18 years old as the object , with the stratified random sampling ,the questionnaire survey sampled 6 communities and 4 drug stores and reclaimed 656 valid questionnaires all together. The softwares of Epidata3.0、SPSS12.0 was used in data analysis with descriptive statistics,χ2 test and Logistic regression. The qualitative data derived from the behavior observation of the citizens in self-medication, in-depth interview with the employees and pharmacists of the drugstores.Results1.The primary self-diagnose base is individual experience(66.2%),others are consultation to the employee of the drugstore(14.8%)and drug instructions(6.3%),the citizens of low education degree or the older are apt to self-diagnose by individual experience more, while the younger based on consultation to employee of the drugstore and drug advertisement more and high education degree citizens based on book/magazine/net more in self-diagnose.There are 83.8% citizens notice the production date and period of validity when they bought medicines, 87.5% of them read the instruction before dosing, while 30.1% of them understood it entirely. The older and the low education degree did not like to read the instructions. 13.7% of them dosed mistakenly, 65.2% stop dosing when they felt better. The citizens of low education degree did not consider the storage conditions when they save the residual medication.2. The medication knowledge of the citizens of high education degree was more significantly than which of the citizens of low education degree. There were pertinence between the knowledge and the behavior, the group of higher score in knowledge had the more safe behavior than the group of lower score.Worse self-efficacy and self-confidence were the risk factors for self-medication; right knowledge of dosing pose was the protected factor. There were relationship between the medical insurance condition and the medicine purchase in appointed drugstore where the expenses can be compensated.3. 52.9%of the sample replaced drug frequently,57.0%prolong or shorten the period of treatment and 55.2%added or reduced the dosage during using drug,especially the youger and the higher in education;30.2%had the mistakes in self-diagnose, 15.6% chose the improper medicine because of the advertisement, 11.7% used drug inappropriately for misunderstanding the drug instructions;26.8%used the different medicines with the same indications at one time, 23.8% used the drugs with the same generic but different brand names at one time;19.7% abused febrifuge and anodyne,42.4%abused antibiotics ; 13.3% misused drug because they were regardless of the contraindication in the instructions,16.0%did not consider the dietetic taboo during dosing, especially the younger.35.7%did not consider the physical characteristic of himself during self-medication;37.2%had drug harm on health besides the side-effect of the drug itself during self-medication, especially the older.4. The result of Logistic regression shows that few mistakes in self-diagnose was the protected factor of self-medication, while prescription drugs can be bought without prescription and used the drugs with the same generic but different brand names at one time were the risky factors of self-medication.Conclusions and SuggestionsThe research brought forward behavior intervention suggestions as following:1. Reinforce the education on the knowledge of self-medication to the citizens.2. Implement the self-management of the behavior, mold the low-risk self-medication behavior of the citizens.3. Intensity the distribution management of prescription drugs, popularize the GPP.4. Exert adequately the function of pharmaceutical care of the certified pharmacist in the drugstore, fabricate drug use record for the citizens.5. Potentiate supervision and management of drug advertisements, the government promulgate the authoritative information about medicines.6. Standardize the format and content of drug instructions, spark plug the right-using of the instructions.更多还原