Vanelli Mark, Coca-Perraillon Marcelo, Troxell-Dorgan Amy
Adheris, Inc., Burlington, Massachusetts, USA.
Clin Ther. 2007 Dec;29(12):2768-73. doi: 10.1016/j.clinthera.2007.12.023.
We report on differences in atypical antipsychotic adherence after the start of outpatient treatment with atypical antipsychotics in patients receiving routine clinical care, based on whether they had been dispensed antipsychotic medication during the previous 180 days. We hypothesized that prior receipt of an antipsychotic prescription would identify patients with a reduced risk for medication discontinuation, perhaps due to greater experience with illness and/or medication experience.
De-identified computerized pharmacy records of 406,032 patients from 1157 pharmacies throughout the United States were used to select patients who were dispensed a noninjectable atypical antipsychotic between October 1, 2003, and March 31, 2004. Patients receiving an atypical antipsychotic prescription during this enrollment period were divided into 2 groups. One group consisted of patients to whom antipsychotic medications had been dispensed in the 180-day period prior to the index outpatient fill. The other group was composed of individuals who had not been dispensed a conventional or atypical antipsychotic during this period. Adherence was measured using Kaplan-Meier time-to-discontinuation analysis during a 360-day follow up period after the enrollment date. Discontinuation was defined as being 30 days late for a scheduled refill.
Patients without receipt of an antipsychotic in the 180-day period prior to the index fill composed 32.6% of the total sample of patients (N = 406,432). Women composed 55.2% of the sample; men, 44.8%. The mean age was 43.7 years. In patients previously dispensed an antipsychotic medication, the median time to discontinuation was 125 days, while in patients not previously dispensed an antipsychotic medication, this value was 34 days.
In this analysis of data from pharmacy records, past antipsychotic use appeared to be associated with atypical antipsychotic adherence. Patients without evidence of having been dispensed antipsychotic medication during the 180 days prior to the index antipsychotic prescription appeared to have a high risk for medication discontinuation in the first 30 days after the start of outpatient therapy. This finding suggests that close follow-up during that period in patients who are either new to antipsychotic medication or who are being restarted on an antipsychotic after a prolonged lapse in use may be beneficial.
我们报告了在接受常规临床护理的患者中，开始使用非典型抗精神病药物进行门诊治疗后，非典型抗精神病药物依从性的差异，这取决于他们在过去180天内是否曾被配给过抗精神病药物。我们假设，先前接受过抗精神病药物处方的患者停药风险会降低，这可能是由于对疾病和/或药物使用有更多经验。
利用来自美国1157家药房的406,032名患者的匿名计算机化药房记录，筛选出在2003年10月1日至2004年3月31日期间被配给非注射用非典型抗精神病药物的患者。在该入组期间接受非典型抗精神病药物处方的患者被分为两组。一组由在索引门诊配药前180天内曾被配给抗精神病药物的患者组成。另一组由在此期间未被配给传统或非典型抗精神病药物的个体组成。在入组日期后的360天随访期内，使用Kaplan-Meier停药时间分析来测量依从性。停药被定义为预定的再填充延迟30天。
在索引配药前180天内未接受抗精神病药物治疗的患者占患者总样本的32.6%（N = 406,432）。样本中女性占55.2%；男性占44.8%。平均年龄为43.7岁。在先前曾被配给抗精神病药物的患者中，停药的中位时间为125天，而在先前未被配给抗精神病药物的患者中，这一值为34天。
在这项对药房记录数据的分析中，过去使用抗精神病药物似乎与非典型抗精神病药物的依从性有关。在索引抗精神病药物处方前180天内没有证据表明曾被配给抗精神病药物的患者，在门诊治疗开始后的前30天内似乎有很高的停药风险。这一发现表明，在抗精神病药物治疗新手或长期停药后重新开始使用抗精神病药物的患者中，在该期间进行密切随访可能是有益的。
