van Geffen Erica C G, van Hulten Rolf, Bouvy Marcel L, Egberts Antoine C G, Heerdink Eibert R
Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands.
Ann Pharmacother. 2008 Feb;42(2):218-25. doi: 10.1345/aph.1K516. Epub 2007 Dec 19.
Studies have shown that up to 38% of patients who start treatment with antidepressants fill only a single prescription at the pharmacy, apparently not accepting treatment.
To determine characteristics and reasons associated with nonacceptance of selective serotonin-reuptake inhibitor (SSRI) treatment.
A retrospective study was conducted in 37 community pharmacies in the Netherlands; patients who presented a prescription from a general practitioner (GP) for a newly started SSRI treatment were selected. Nonaccepters were defined as patients who filled only one SSRI prescription; patients who received at least 3 fills of an SSRI prescription were defined as accepters. Patient characteristics were obtained from automated dispensing records and from questionnaires. Areas of evaluation included sociodemographics, disease, and treatment. Nonaccepters were asked their reasons for not filling second prescriptions.
Of the patients who started SSRI treatment, 22.0% were nonaccepters, filling only a single prescription. Fifty-seven nonaccepters and 128 accepters were included in our analysis. Nonacceptance was more common among patients with a low level of education (OR 2.6; 95% CI 1.1 to 5.9) and in patients who reported nonspecific symptoms like fatigue, stress, and restlessness as the reason for SSRI use (OR 2.7; 95% CI 1.4 to 5.5). Of the nonaccepters, 29.8% (n = 17) did not start SSRI use, and 70.2% (n = 40) discontinued SSRI use within 2 weeks. Fear of adverse effects and the actual occurrence of adverse effects were main reasons for not accepting SSRI treatment. Of the nonaccepters, 55.0% discontinued treatment without informing their GPs.
Acceptance of SSRI treatment is a decisive moment in a patient's adherence to treatment initiated by his or her GP and deserves more attention; GPs and pharmacists should address treatment issues, especially in groups at risk for nonacceptance.
研究表明，开始使用抗抑郁药治疗的患者中，高达38%的人仅在药房配了一次药，显然未接受治疗。
确定与不接受选择性5-羟色胺再摄取抑制剂（SSRI）治疗相关的特征和原因。
在荷兰的37家社区药房进行了一项回顾性研究；选择那些从全科医生（GP）处拿到新开始使用SSRI治疗处方的患者。不接受治疗者定义为仅配了一次SSRI处方的患者；接受至少3次SSRI处方配药的患者定义为接受治疗者。患者特征从自动配药记录和问卷调查中获取。评估领域包括社会人口统计学、疾病和治疗。询问不接受治疗者不配第二次处方的原因。
在开始使用SSRI治疗的患者中，22.0%为不接受治疗者，仅配了一次药。我们的分析纳入了57名不接受治疗者和128名接受治疗者。不接受治疗在低教育水平患者中更为常见（比值比2.6；95%置信区间1.1至5.9），在那些报告将疲劳、压力和烦躁不安等非特异性症状作为使用SSRI原因的患者中也更为常见（比值比2.7；95%置信区间1.4至5.5）。在不接受治疗者中，29.8%（n = 17）未开始使用SSRI，70.2%（n = 40）在2周内停用了SSRI。对不良反应的恐惧和实际发生的不良反应是不接受SSRI治疗的主要原因。在不接受治疗者中，55.0%未告知其全科医生就停止了治疗。
接受SSRI治疗是患者坚持其全科医生启动的治疗过程中的一个决定性时刻，值得更多关注；全科医生和药剂师应处理治疗问题，尤其是在有不接受治疗风险的群体中。
