Objective  To investigate the current status of medication adherence among primary care patients in Shandong Province, and to analyze the influencing factors, and propose targeted intervention measures.

Methods  A multi-stage, stratified random sample of 35 primary medical institutions was drawn from 6 cities representing different geographical regions and levels of economic development in Shandong Province. Consecutive out-patients presenting between August 11 and 20, 2023 were invited to participate. The Morisky Medication Adherence Scale was used to assess patients' medication adherence, and Logistic regression was used to identify influencing factors.

Results  A total of 6,328 participants were enrolled, including 2,981 males (47.1%) and 3,347 females (52.9%). The highest proportion (44.6%) was among those aged 60-74 years, and 39.5% were from western Shandong. Morisky scores ranged from 4 to 8; 3,136 patients (49.6%) scored >6. Age, regional economic level and disease type were associated with adherence (P<0.05). Logistic regression showed that patients in areas with higher economic development had better medication adherence (P<0.05), while those without hypertension or diabetes were less adherent (P<0.05).

Conclusion  The overall level of medication adherence among primary care patients in Shandong Province is suboptimal. It is recommended that relevant departments strengthen health education and conduct rational medication popularization based on potential influencing factors to improve patients' medication adherence and treatment outcomes.

1.Kwan YH, Weng SD, Loh DHF, et al. Measurement properties of existing patient-reported outcome measures on medication adherence:systematic review[J]. J Med Internet Res, 2020, 22(10): e19179. DOI: 10.2196/19179.

2.田敬林, 徐洋, 陈荣飞, 等. Ⅱ型糖尿病患者给予临床合理用药指导对其用药依从性的影响[J]. 北方药学, 2022, 19(8): 188-190. [Tian JL, Xu Y, Chen RF, et al. The impact of providing clinical rational drug use guidance to type 2 diabetes patients on their medication compliance[J]. Journal of North Pharmacy, 2022, 19(8): 188-190.] DOI: 10.3969/j.issn.1672-8351.2022.08.058.

3.Burkhart PV, Sabaté E. Adherence to long-term therapies: evidence for action[J]. J Nurs Scholarsh, 2003, 35(3): 207. DOI: 10.1590/S0102-311X2005000400037.

4.王维娜, 沈素. 门诊老年慢性病患者用药依从性及其影响因素的调查分析与药师干预措施[J]. 中国医药导报, 2016, 13(11): 52-55, 59. [Wang WN, Shen S. Analysis of related factors of medication compliance in elderly patients with chronic diseases and intervention measures of pharmacists[J]. China Medical Herald, 2016, 13(11): 52-55, 59.] https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201611014.htm.

5.刘英娟. 山东省肥城地区人类免疫缺陷病毒感染特点及用药依从性影响因素分析[J]. 医药前沿, 2025, 15(1): 27-31. [Liu  YJ, Characteristics of human immunodeficiency virus infection and influencing factors of medication compliance in Feicheng area of Shandong Province[J]. Journal of Frontiers of Medicine, 2025, 15(1): 27-31.] DOI: 10.20235/j.issn.2095-1752.2025.01.006.

6.高敏, 李晓娜, 时永利, 等. 老年慢性病患者用药体验对用药依从性的影响研究[J]. 中国全科医学, 2025, 28(11): 1309-1314. [Gao M, Li XN, Shi YL, et al. Influencing factors for medication experience and medication adherence in elderly patients with chronic diseases[J]. Chinese General Practice, 2025, 28(11): 1309-1314.] DOI: 10.12114/j.issn.1007-9572.2024.0137.

7.高永祥, 张晋昕. Logistic回归分析的样本量确定[J]. 循证医学, 2018, 18(2): 122-124. [Gao YX, Zhang JX, Determination of sample size in logistic regression analysis[J]. The Journal of Evidence-Based Medicine, 2018, 18(2): 122-124.] DOI: 10.12019/j.issn.1671-5144.2018.02.015.

8.吴园园, 黄凌斐, 罗优优, 等. 中文版Morisky服药依从性评估量表在炎症性肠病患儿中应用的信效度评价[J]. 中国现代应用药学, 2023, 40(22): 3117-3123. [Wu YY, Huang  LF, Luo YY, et al. Reliability and validity of morisky medication adherence scale for assessing medication adherence in children with inflammatory bowel disease[J]. Chinese Journal of Modern Applied Pharmacy, 2023, 40(22): 3117-3123.] DOI: 10.13748/j.cnki.issn1007-7693.20232567.

9.李坤, 梁会营, 李恂, 等. Morisky问卷应用于社区高血压患者服药依从性评价的信度和效度分析[J].中华高血压杂志, 2010, 18(11): 1067-1070. [Li K, Liang HY, Li X, et al. Validity and reliability of the morisky questionnaire in assessing antihypertensive therapy compliance of hypertension patients in community[J]. Chinese Journal of Hypertension, 2010, 18(11): 1067-1070.] DOI: 10.16439/j.cnki.1673-7245.2010.11.021.

10.杨李华, 段韶军, 杨柳, 等. 晋城市居民用药安全行为风险知识-态度-行为调查研究[J]. 临床医药实践, 2022, 31(2): 129-132. [Yang LH, Duan SJ, Yang L, et al. Investigation on the risk knowledge-attitude-behavior of medication safety behaviors among residents in Jincheng City[J]. Proceeding of Clinical Medicine, 2022, 31(2): 129-132.] DOI: 10.16047/j.cnki.cn14-1300/r.2022.02.010.

11.Stewart RB, Weedle PB, Poston JW, et al. Drug prescribing in residential homesfor elderly people in the United Kingdom[J]. DICP, 1990, 24(5): 533-536. DOI: 10.1177/106002809002400513.

12.王金明, 林盛强, 杨玉明, 等. 社区共病患者服药依从性及影响因素调查分析[J]. 中国全科医学, 2017, 20(23): 2827-2831. [Wang JM, Lin SQ, Yang YM, et al. Medication adherence and its influencing factors of community multimorbidity patients[J]. Chinese General Practice, 2017, 20(23): 2827-2831.] DOI: 10.3969/j.issn.1007-9572.2017.04.y03.

13.赵威, 赵志刚, 武明芬. 中国老年慢性病患者居家用药依从性现状及影响因素: 基于全国横断面调查[J]. 医药导报, 2025, 44(12): 1948-1955. [Zhao W, Zhao ZG, Wu MF. Home medication adherence and its influencing factors among elderly patients with chronic diseases in China: a national cross-sectional survey[J]. Herald of Medicine, 2025, 44(12): 1948-1955.] DOI: 10.3870/j.issn.1004-0781.2025.12.011.

14.彭路, 杨雅麟, 韩爽, 等. 老年高血压患者用药依从性影响因素分析[J]. 临床药物杂志, 2019, 11(17): 57-61. [Peng  L, Yang YL, Han S, et al. Analysis of influencing factors of medication adherence in elderly patients with hypertension[J]. Clinical Medication Journal, 2019, 11(17): 57-61.] DOI: 10.3969/j.issn.1672-3384.2019.11.013.

15.戴烨, 周晨霞, 陈川, 等. 老年高血压患者用药依从性影响因素分析[J]. 首都食品与医药, 2017, 24(18): 74-75. [Dai  Y, Zhou CL, Chen C, et al. Analysis of influencing factors of medication compliance of elderly hypertension patients[J]. Capital Food Medicine, 2017, 24(18): 74-75.] DOI: 10.3969/j.issn.1005-8257.2017.18.054.

16.宁文奇, 李鼎, 杨丽萍, 等. 沈阳市住院高血压患者用药依从性分析[J]. 中国公共卫生, 2024, 40(12): 1511-1514. [Ning WQ, Li D, Yang LP, et al. Medication adherence among hospitalized hypertension patients in Shenyang city[J]. Chinese Journal of Public Health, 2024, 40(12): 1511-1514.] DOI: 10.11847/zgggws1144221.

17.李慧, 孟庆跃, 涂诗意, 等. 山东农村居民高血压患者服药依从性及其影响因素分析[J]. 中国卫生事业管理, 2008(7): 478-480. [Li H, Meng QY, Tu SY, et al. Analysis of medication compliance and its influencing factors among hypertensive patients in rural areas of Shandong Province[J]. Chinese Health Service Management, 2008(7): 478-480.] DOI: 10.3969/j.issn.1004-4663.2008.07.019.

18.叶向阳, 候潘婷, 李真真, 等. 河南省大学生疾病年轻化现状调查与影响因素分析[J]. 产业与科技论坛, 2023, 22(23): 82-84. [Ye XY, Hou PT, Li ZZ, et al. Investigation on the current situation of younger age of diseases among college students in Henan Province and analysis of influencing factors[J]. Industrial & Science Tribune, 2023, 22(23): 82-84.] DOI: 10.3969/j.issn.1673-5641.2023.23.021.

19.赵媛媛, 徐建潍. 老年高血压患者用药依从性调查及相关影响因素分析[J]. 实用医药杂志, 2019, 36(12): 1099-1100. [Zhao  YY, Xu JW. Investigation on medication compliance of elderly patients with hypertension and analysis of related influencing factors[J]. Practical Journal of Medicine & Pharmacy, 2019, 36(12): 1099-1100.] DOI: 10.14172/j.issn1671-4008.2019.12.014.

20.李颖鑫. 不同人群高血压患者用药依从性及影响因素分析 [J]. 心理月刊, 2019, (5): 134. [Li YX. Analysis of medication compliance and its influencing factors in hypertensive patients of different populations[J]. Psychological Monthly, 2019, (5): 134.] DOI: 10.19738/j.cnki.psy.2019.05.128.

21.周景想, 唐明, 李洁, 等. 山东沿海地区与内陆地区冠心病心绞痛证候特点差异[J]. 中医杂志, 2011, 52(18): 1573-1576. [Zhou JX, Tang M, Li J, et al. Different features of TCM syndromes of angina pectoris of coronary heart disease in Shandong coastal region and inland area[J]. Journal of Traditional Chinese Medicine, 2011, 52(18): 1573-1576.] DOI: 10.13288/j.11-2166/r.2011.18.011.

22.郑珊珊, 李建涛, 许云晶, 等. 传统药学服务与“互联网+药学服务”中的用药指导现状及患者需求分析[J]. 中国药学杂志, 2022, 57(11): 955-960. [Zheng SS, Li JT, Xu YJ, et al. Current situation of medication instruction and patients′ need analysis during pharmaceutical service between traditional model and "internet plus" model[J]. Chinese Pharmaceutical Journal, 2022, 57(11): 955-960.] DOI: 10.11669/cpj.2022.11.013.

23.蔡蕊, 汤伟. 药学干预对2型糖尿病患者用药依从性及药品不良反应的影响[J]. 世界最新医学信息文摘, 2019, 19(91): 195-199. [Cai R, Tang W. The impact of pharmaceutical intervention on medication compliance and adverse drug reactions in patients with type 2 diabetes[J]. World Latest Medicine Information, 2019, 19(91): 195-199.] DOI: 10.19613/j.cnki.1671-3141.2019.91.133.

24.刘宇丹, 张彩云, 郭明媚, 等. 慢性病共病患者服药依从性影响因素的Meta分析[J]. 预防医学, 2024, 36(9): 790-795, 800. [Liu YD, Zhang CY, Guo MM, et al. Influencing factors for medication compliance in patients with comorbidities of chronic diseases: a meta-analysis[J]. China Preventive Medicine Journal, 2024, 36(9): 790-795, 800.] DOI: 10.19485/j.cnki.issn2096-5087.2024.09.013.

25.罗燕, 段棣飞, 马登艳, 等. 慢性肾脏病合并高血压患者的高血压治疗依从性调查分析[J]. 广西医学, 2021, 43(8): 1027-1031, 1038. [Luo Y, Duan DF, Ma DY, et al. Survey on compliance for hypertension treatment in hypertensive patients complicated with chronic kidney diseases[J]. Guangxi Medical Journal, 2021, 43(8): 1027-1031, 1038.] DOI: 10.11675/j.issn.0253-4304.2021.08.27.

26.Persell SD, Karmali KN, Lee JY, et al. Associations between health literacy and medication self-management among community health center patients with uncontrolled hypertension[J]. Patient Prefer Adherence, 2020, 14: 87-95. DOI: 10.2147/PPA.S226619.

27.张锦云, 张丽芹, 陶美霞, 等. 老年2型糖尿病患者用药依从性现状及影响因素分析[J]. 实用预防医学, 2024, 31(11): 1382-1385. [Zhang JY, Zhang LQ, Tao MX, et al. Status quo of medication compliance and its influencing factors among elderly patients with type 2 diabetes mellitus[J]. Practical Preventive Medicine, 2024, 31(11): 1382-1385.] DOI: 10.3969/j.issn.1006-3110.2024.11.025.

28.Zheng F, Ding S, Lai L, et al. Relationship between medication literacy and medication adherence in inpatients with coronary heart disease in Changsha, China[J]. Front Pharmacol, 2020, 10: 1537. DOI: 10.3389/fphar.2019.01537.

29.姚红萍, 陆叶, 郑茹, 等. 2型糖尿病患者用药特征及服药依从性的相关性研究[J]. 安徽医学, 2022, 43(9): 1030-1034. [Yao HP, Lu Y, Zheng R, et al. A study on the correlation between medication characteristics and medication compliance in patients with type 2 diabetes[J]. Anhui Medical Journal, 2022, 43(9): 1030-1034.] DOI: 10.3969/j.issn.1000-0399.2022.09.009.

30.李雅, 王建国, 张红杰. 社区2型糖尿病老年患者用药依从性调查分析[J]. 中国药物滥用防治杂志, 2024, 30(2): 252-254, 263. [Li Y, Wang JG, Zhang HJ. Investigation and analysis of medication compliance of elderly patients with type 2 diabetes mellitus in community[J]. Chinese Journal of Drug Abuse Prevention and Treatment, 2024, 30(2): 252-254, 263.] DOI: 10.15900/j.cnki.zylf1995.2024.02.015.

31.胡薏慧, 杨晓燕, 汤洁, 等. 对药物临床试验老年受试者依从性管理的建议[J]. 药物评价研究, 2024, 47(3): 457-462. [Hu Y, Yang X, Tang J, et al. Recommendations for compliance management of elderly participants in drug clinical trials[J]. Drug Evaluation Research, 2024, 47(3): 457-462.] DOI: 10.7501/j.issn.1674-6376.2024.03.001.

32.陈莹莹, 朱高培, 薛付忠. 主动健康管理模式下山东省老年人服药依从性现状及影响因素分析[J/OL].中国全科医学, 2025-03-13. [Chen YY, Zhu GP, Xue  FZ. Analysis of the current situation and influencing factors of medication adherence among the elderly in Shandong Province under an active health management model[J/OL]. Chinese General Practice, 2025-03-13.] DOI: 10.12114/j.issn.1007-9572.2024.0134.

33.刘璐瑶, 蔡昳, 沈杰, 等. 一般用药信念对老年2型糖尿病患者续配和服药依从性的影响[J]. 复旦学报（医学版）, 2022, 49(2): 234-240. [Liu LY, Cai Y, Shen J, et al. The correlation between medication adherence and beliefs about medication in elderly patients with type 2 diabetes[J]. Fudan University Journal of Medical Sciences, 2022, 49(2): 234-240.] DOI: 10.3969/j.issn.1672-8467.2022.02.011.

34.关新月, 王萧冉, 张丹. 老年共病患者服药依从性及其影响因素研究[J]. 中国全科医学, 2024, 27(20): 2520-2526. [Guan  XY, Wang XR, Zhang D. Study of medication adherence and its influencing factors among elderly patients with multimorbidity[J]. Chinese General Practice, 2024, 27(20): 2520-2526.] DOI: 10.12114/j.issn.1007-9572.2023.0674.

35.方倩, 李德琴, 詹静, 等. 基于结构方程模型的老年2型糖尿病患者医院-家庭过渡期用药依从性的影响路径[J]. 中国药物与临床, 2025, 25(12): 778-782. [Fang Q, Li DQ, Zhan J, et al. Pathway analysis of influencing factors on medication compliance of elderly patients with type 2 diabetes in hospital-to-home transition period based on a structural equation model[J]. Chinese Remedies & Clinics, 2025, 25(12): 778-782.] DOI: 10.11655/zgywylc2025.12.006.

36.冒长青, 高晓, 聂莲莲, 等. 713名居家糖尿病患者用药依从性分析[J]. 中国药业, 2023, 32(21): 30-34. [Mao CQ, Gao X, Nie LL, et al. Medication compliance of 713 home-based diabetic patients[J]. China Pharmaceuticals, 2023, 32(21): 30-34.] DOI: 10.3969/j.issn.1006-4931.2023.21.008.