Hudson Teresa J, Owen Richard R, Thrush Carol R, Han Xiaotong, Pyne Jeffrey M, Thapa Purushottam, Sullivan Greer
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, VA Medical Center (152/NLR), 2200 Ft. Roots Drive, North Little Rock, AR 72114-1706, USA.
J Clin Psychiatry. 2004 Feb;65(2):211-6. doi: 10.4088/jcp.v65n0211.
Interventions to improve adherence to antipsychotic medication are needed. The aims of the current study were to identify the most common barriers to medication adherence in a cohort of patients receiving outpatient and inpatient treatment for an acute exacerbation of schizophrenia, compare clinical and demographic characteristics of patients with lower versus higher numbers of barriers, and characterize patients most likely to be nonadherent to antipsychotic medication.
The present study analyzed data collected during the Schizophrenia Guidelines Project (SGP), a multisite study of strategies to implement practice guidelines that was funded by the U.S. Department of Veterans Affairs and conducted from March 1999 to October 2000. Nurse coordinators had conducted clinical assessments and performed an intervention designed to improve medication adherence by addressing barriers to adherence. Data on patient symptoms, functioning, and side effects had been obtained using the Positive and Negative Syndrome Scale (PANSS), the Schizophrenia Outcomes Module, the Medical Outcomes Study 36-item Short-Form Health Survey, and the Barnes Akathisia Scale (BAS). Administrative data were used to identify patients with an ICD-9 code for schizophrenia. A total of 153 patients who met this criterion and participated in the intervention arm of the SGP had complete data available for analysis in the current study.
The most common patient-reported barriers were related to the stigma of taking medications, adverse drug reactions, forgetfulness, and lack of social support. Bivariate analysis showed that patients with high barriers were significantly more likely to be nonadherent (p < or =.02), to have problems with alcohol or drug use (p =.02), to have higher PANSS total scores (p =.03), and to have higher mean BAS scores (p =.02). Logistic regression showed that lower patient education level (odds ratio [OR] = 3.95, p =.02), substance abuse (OR = 3.24, p =.01), high PANSS total scores (OR = 1.02, p =.05), and high barriers (OR = 2.3, p =.05) were significantly associated with the probability of nonadherence.
It may be possible to identify patients most likely to benefit from adherence intervention. The data presented here will help to inform future research of clinical interventions to improve medication adherence in schizophrenia and help to stimulate further work in this area.
需要采取干预措施来提高抗精神病药物的依从性。本研究的目的是确定一组因精神分裂症急性加重而接受门诊和住院治疗的患者中，药物依从性最常见的障碍，比较障碍数量较少与较多的患者的临床和人口统计学特征，并描述最有可能不依从抗精神病药物治疗的患者特征。
本研究分析了在精神分裂症指南项目（SGP）期间收集的数据，该项目是一项由美国退伍军人事务部资助、于1999年3月至2000年10月开展的关于实施实践指南策略的多中心研究。护士协调员进行了临床评估，并实施了一项旨在通过解决依从性障碍来提高药物依从性的干预措施。使用阳性和阴性症状量表（PANSS）、精神分裂症结局模块、医学结局研究36项简短健康调查和巴恩斯静坐不能量表（BAS）获取了患者症状、功能和副作用的数据。行政数据用于识别患有ICD-9精神分裂症编码的患者。共有153名符合该标准并参与SGP干预组的患者拥有可用于本研究分析的完整数据。
患者报告的最常见障碍与服药的耻辱感、药物不良反应、健忘和缺乏社会支持有关。双变量分析显示，障碍较多的患者更有可能不依从（p≤0.02）、有酒精或药物使用问题（p = 0.02）、PANSS总分较高（p = 0.03）以及BAS平均得分较高（p = 0.02）。逻辑回归显示，患者教育水平较低（比值比[OR]=3.95，p = 0.02）、药物滥用（OR = 3.24，p = 0.01）、PANSS总分较高（OR = 1.02，p = 0.05）以及障碍较多（OR = 2.3，p = 0.05）与不依从的可能性显著相关。
有可能识别出最有可能从依从性干预中获益的患者。此处呈现的数据将有助于为未来改善精神分裂症药物依从性的临床干预研究提供信息，并有助于推动该领域的进一步工作。
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