الملخص
Objective:To investigate risk factors for the efficacy for appropriate medication use in elderly patients with type 2 diabetes mellitus(T2DM)and to establish a risk prediction model for the efficacy for appropriate medication use by using Logistic regression analysis and the receiver operating characteristic(ROC)curve.Methods:A total of 305 elderly patients with T2DM admitted to pharmacy department of our hospital from Jan.2018 to Aug.2018 were enrolled in this retrospective study.Of the 305 patients, 166(54.4%)were female, with a mean age of (74.9±7.2) years old, a disease course of (15.2±9.6) years and a hospital stay of (10.4±3.2) d, receiving (2.0±0.9) types of antidiabetic drugs.Patients were assessed by the Self-Efficacy for Appropriate Medication Use Scale(SEAMS), the Morisky Medication Adherence Scale-8(MMAS), the Adherence to Refills and Medications Scale(ARMS), the Charlson Comorbidity Index(CCI)and the Mini Mental State Exam(MMSE). Main biochemical indicators were recorded.The influencing factors for appropriate medication use efficacy were analyzed by Logistic regression analysis, and a risk prediction model was consequently established by the ROC curve.Results:According to SEAMS results, 233 patients(76.4%)had sufficient efficacy(≥26 points)and 72 patients(23.6%)had insufficient efficacy(<26 points). There were significant differences in parameters including age, disease course, hospital stay and fasting blood glucose(FBG)between the above two groups( P<0.05). Logistic regression analysis showed that age, FBG level and ARMS score had correlation with self-efficacy for appropriate medication use( P<0.05). ROC curves showed that the predictive efficiency of joint predictor Y [Logit(P)=-15.164+ 0.434X ARMS score-0.067X age-0.082X FBG reaching standard]was better than that of the other three single factors(AUC=0.910, 95% CI: 0.873-0.947, P<0.01)and could be used as an optimal predictor for the evaluation of self-efficacy for appropriate medication use. Conclusions:Compared with MMAS, ARMS is more suitable for medication adherence assessment in elderly T2DM patients.In clinical practice, pharmacists can provide individualized medication services through evaluating the efficacy of rational drug use and the risk prediction model, in order to elevate the ability of self-medication management and quality of life.