Briesacher Becky A, Gurwitz Jerry H, Soumerai Stephen B
Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Biotech Four, Suite 315, 377 Plantation Street, Worcester, MA 01605, USA.
J Gen Intern Med. 2007 Jun;22(6):864-71. doi: 10.1007/s11606-007-0180-x. Epub 2007 Apr 5.
Up to 32% of older patients take less medication than prescribed to avoid costs, yet a comprehensive assessment of risk factors for cost-related nonadherence (CRN) is not available. This review examined the empirical literature to identify patient-, medication-, and provider-level factors that influence the relationship between medication adherence and medication costs.
We conducted searches of four databases (MEDLINE, CINAHL, Sciences Citations Index Expanded, and EconLit) from 2001 to 2006 for English-language original studies. Articles were selected if the study included an explicit measure of CRN and reported results on covarying characteristics.
We found 19 studies with empirical support for concluding that certain patients may be susceptible to CRN: research has established consistent links between medication nonadherence due to costs and financial burden, but also to symptoms of depression and heavy disease burden. Only a handful of studies with limited statistical methods provided evidence on whether patients understand the health risks of CRN or to what extent clinicians influence patients to keep taking medications when faced with cost pressures. No relationship emerged between CRN and polypharmacy.
Efforts to reduce cost-related medication nonadherence would benefit from greater study of factors besides the presence of prescription drug coverage. Older patients with chronic diseases and mood disorders are at-risk for CRN even if enrolled in Medicare's new drug benefit.
高达32%的老年患者为避免费用而服用的药物少于规定剂量，但目前尚无对与费用相关的不依从性（CRN）风险因素的全面评估。本综述对实证文献进行了研究，以确定影响药物依从性与药物费用之间关系的患者、药物和医疗服务提供者层面的因素。
我们检索了2001年至2006年四个数据库（MEDLINE、CINAHL、科学引文索引扩展版和EconLit）中的英文原创研究。如果研究包括对CRN的明确测量并报告了相关特征的结果，则选择这些文章。
我们发现19项研究有实证支持，可得出某些患者可能易患CRN的结论：研究已确定因费用导致的药物不依从性与经济负担之间存在一致的联系，同时也与抑郁症状和重病负担有关。只有少数采用有限统计方法的研究提供了证据，表明患者是否了解CRN的健康风险，或者在面临费用压力时临床医生在多大程度上影响患者继续服药。CRN与多重用药之间未发现关联。
除了有处方药保险外，对其他因素进行更多研究将有助于减少与费用相关的药物不依从性。患有慢性疾病和情绪障碍的老年患者即使参加了医疗保险的新药福利，也有CRN的风险。
