Kulkarni Amit S, Balkrishnan Rajesh, Anderson Roger T, Edin Heather M, Kirsch Jeff, Stacy Mark A
Department of Pharmacy Practice and Administration, The Ohio State University, Columbus, Ohio 43210, USA.
Mov Disord. 2008 Feb 15;23(3):359-65. doi: 10.1002/mds.21831.
Maintenance of symptom control in Parkinson's disease (PD) requires continuous titration of medication and addition of multiple therapies over the course of the disease. Adherence to medication is vital to symptom control and key to maximizing the efficacy of existing therapies. However, adherence is compromised by a variety of factors, including motor symptoms, complex dosing regimens, multiple medications, and lack of patient/physician awareness of the impact and prevalence of suboptimal adherence. This retrospective, longitudinal cohort study assessed the prevalence of suboptimal adherence [measured as the medication possession ratio (MPR)] to PD medications, and its impact on the worsening of PD symptoms (measured as increase in monotherapy dose, augmentation of therapy, PD-related emergency department visit, or hospitalization), in a Medicare Health Maintenance Organization population in the United States. Irrespective of the MPR threshold chosen, a high percentage of patients were categorized as suboptimally adherent to their PD medications, and patients with suboptimal adherence to their PD medications had higher risks of worsening of PD symptoms, compared with those who were adherent. Increased awareness of both the magnitude and impact of suboptimal adherence to PD medications, coupled with dosage simplification and a unified effort by healthcare professionals and patients, may improve adherence to PD medications and ultimately improve symptom control.
帕金森病（PD）症状控制的维持需要在疾病过程中持续调整药物剂量并增加多种治疗方法。坚持服药对症状控制至关重要，也是使现有治疗方法疗效最大化的关键。然而，多种因素会影响服药依从性，包括运动症状、复杂的给药方案、多种药物以及患者/医生对依从性欠佳的影响和普遍性缺乏认识。这项回顾性纵向队列研究评估了美国医疗保险健康维护组织人群中帕金森病药物依从性欠佳（以药物持有率（MPR）衡量）的患病率，及其对帕金森病症状恶化（以单药治疗剂量增加、治疗强化、帕金森病相关急诊就诊或住院衡量）的影响。无论选择何种MPR阈值，都有很大比例的患者被归类为帕金森病药物依从性欠佳，与依从的患者相比，帕金森病药物依从性欠佳的患者帕金森病症状恶化的风险更高。提高对帕金森病药物依从性欠佳的程度和影响的认识，同时简化给药剂量，并由医疗保健专业人员和患者共同努力，可能会提高帕金森病药物的依从性，并最终改善症状控制。
