Woltmann Emily M, Valenstein Marcia, Welsh Deborah E, Lee Todd A, Wolschon Patricia A, Grabowski John, Reilly Peter A
Dartmouth Psychiatric Research Center, NH, USA.
Psychiatr Serv. 2007 Jun;58(6):864-7. doi: 10.1176/ps.2007.58.6.864.
Low adherence to antipsychotic medications is a risk factor for poor outcomes for people with serious mental illness. Pharmacy data might be used by health systems to identify partially adherent patients for interventions. This study assessed whether using pharmacy data is an accurate screening method for identifying at-risk patients.
Administrative data were used to identify 1,712 veterans as having schizophrenia or a schizoaffective or bipolar disorder and who had 12-month antipsychotic medication possession ratios (MPRs) of less than .80. Patients' charts were reviewed for alternative explanations for low rates of filling prescriptions for antipsychotic medication.
Of 1,712 patients whose pharmacy data indicated partial adherence (MPRs less than .80), 17% (N=297) may have been adherent. Patients with bipolar disorder had higher odds of receiving a false-positive designation (adjusted odds ratio of 1.8, 95% confidence interval of 1.31-2.39).
MPRs constructed from pharmacy data can be a useful first screen for identifying patients who need assistance with medication adherence.
对抗精神病药物的低依从性是导致严重精神疾病患者预后不良的一个风险因素。卫生系统可以利用药房数据来识别部分依从性患者以便进行干预。本研究评估了使用药房数据是否是识别高危患者的一种准确筛查方法。
利用行政数据确定1712名退伍军人患有精神分裂症、分裂情感性障碍或双相情感障碍，且其12个月的抗精神病药物持有率（MPR）低于0.80。查阅患者病历，以寻找抗精神病药物处方填充率低的其他原因。
在1712名药房数据显示部分依从性（MPR低于0.80）的患者中，17%（N = 297）可能是依从的。双相情感障碍患者被误判为阳性的几率更高（调整后的优势比为1.8，95%置信区间为1.31 - 2.39）。
根据药房数据构建的MPR可以作为识别需要药物依从性帮助患者的一种有用的初步筛查方法。
