Johnson F Reed, Ozdemir Semra, Manjunath Ranjani, Hauber A Brett, Burch Steven P, Thompson Thomas R
RTI Health Solutions, North Carolina, USA.
Med Care. 2007 Jun;45(6):545-52. doi: 10.1097/MLR.0b013e318040ad90.
Medication nonadherence is high among patients with bipolar disorder, and may lead to poor clinical outcomes, decreased quality of life, and increased resource utilization.
To investigate the factors associated with nonadherence and to assess the effect of patient-stated preferences on stated adherence to hypothetical medications.
A choice-format stated-preference Web survey was administered. In each choice question, patients were asked to choose among 2 or 3 different hypothetical medications. Each choice question was followed by a question asking patients about their likely adherence to the selected medication alternative.
Patients (N = 469) with self-reported bipolar disorder completed the survey which was programmed and administered to members of a chronic-illness Web panel.
Factors associated with stated adherence to current treatment were identified. The effects of socioeconomic characteristics and medication attributes on stated adherence to hypothetical medications were assessed.
Patient socioeconomic characteristics affect patients' adherence. Being white and having more education has a significant positive effect on adherence. Self-reported current adherence is a strong factor in predicting adherence for better medications. Medication outcome attributes, especially severity of depressive episodes, strongly influence patients' stated adherence to treatment. Weight gain and cognitive effects of a medication most significantly affected patients' likely adherence to medications for bipolar disorder.
Patients are the final health care decision makers; their satisfaction with a medication is likely to affect whether or not they adhere to the medication prescribed by their physician. In the case of bipolar disorder, this study suggests patients are likely to be more adherent to medications that reduce the severity of depressive episodes and do not cause weight gain or cognitive side effects. By understanding the factors that improve adherence, health care providers can optimize prescribing patterns, which may ultimately lead to more effective management and improvement in the patient's condition.
双相情感障碍患者的药物治疗依从性较差，这可能导致临床疗效不佳、生活质量下降以及资源利用增加。
调查与不依从相关的因素，并评估患者陈述的偏好对假设药物的陈述依从性的影响。
进行了一项选择格式的陈述偏好网络调查。在每个选择问题中，要求患者在2种或3种不同的假设药物中进行选择。每个选择问题之后都会有一个问题，询问患者对所选药物替代方案的可能依从性。
自我报告患有双相情感障碍的患者（N = 469）完成了该调查，该调查针对慢性病网络小组的成员进行编程和管理。
确定与当前治疗的陈述依从性相关的因素。评估社会经济特征和药物属性对假设药物陈述依从性的影响。
患者的社会经济特征会影响患者的依从性。白人且受教育程度较高对依从性有显著的积极影响。自我报告的当前依从性是预测对更好药物依从性的一个重要因素。药物治疗结果属性，尤其是抑郁发作的严重程度，强烈影响患者对治疗的陈述依从性。体重增加和药物的认知作用最显著地影响了患者对双相情感障碍药物的可能依从性。
患者是最终的医疗保健决策者；他们对药物的满意度可能会影响他们是否坚持服用医生开的药。对于双相情感障碍，本研究表明患者可能更愿意坚持服用能减轻抑郁发作严重程度且不会导致体重增加或认知副作用的药物。通过了解提高依从性的因素，医疗保健提供者可以优化处方模式，这最终可能导致对患者病情更有效的管理和改善。
