Carnahan Ryan M, Lund Brian C, Chrischilles Elizabeth A, Perry Paul J
The University of Oklahoma, Department of Pharmacy: Clinical and Administrative Sciences, 4502 E. 41st St., Suite 2H19, Tulsa, OK 74135-2512, USA.
Res Social Adm Pharm. 2008 Dec;4(4):367-74. doi: 10.1016/j.sapharm.2007.11.002. Epub 2008 Aug 8.
Antidepressant nonadherence is a significant threat to clinical outcomes and can be divided into 2 primary domains, persistence and consistency. Although antidepressant persistence has been well described, little is known about consistency patterns.
The primary objective of this study was to characterize consistency among persistent antidepressant users. Patients with depression may also exhibit poor adherence to medications for chronic comorbid conditions. Thus, a second objective was to compare their consistency with chronic, nonpsychiatric medications with that of nonantidepressant users.
Continuously eligible adult patients were selected from the Iowa Medicaid Pharmaceutical Case Management program based on receiving an antidepressant or a selected chronic nonpsychiatric medication for at least the first 4 months after program enrollment. Consistency over the first year of enrollment was determined from prescription refill patterns, using the MED-OUT index.
The mean consistency rate was 86% among the 1122 persistent antidepressant users. Consistency was not significantly different among polyantidepressant users or across the antidepressant classes. Among antidepressant users, consistency with antidepressants was not significantly different from consistency with chronic nonpsychiatric medications. Antidepressant users were not significantly less consistent with chronic nonpsychiatric medications than nonantidepressant users, after controlling for the confounding factors of age, sex, and total number of medications.
Consistency with medications in this population of persistent antidepressant users with medical illnesses was fairly good, and comparable to that of nonantidepressant users. The unique population may have influenced consistency rates. Focusing on persistent antidepressant users may have limited the expected impact of depression on medication consistency.
抗抑郁药治疗依从性差对临床疗效构成重大威胁，可分为两个主要方面，即持续性和连贯性。虽然抗抑郁药的持续性已有充分描述，但对于连贯性模式却知之甚少。
本研究的主要目的是描述持续使用抗抑郁药患者的连贯性情况。抑郁症患者对慢性合并症药物治疗的依从性也可能较差。因此，第二个目的是将他们使用慢性非精神科药物的连贯性与非抗抑郁药使用者进行比较。
从爱荷华医疗补助药品病例管理项目中，选取在项目登记后至少前4个月持续使用抗抑郁药或选定慢性非精神科药物的成年患者。使用MED-OUT指数，根据处方 refill模式确定登记后第一年的连贯性情况。
1122名持续使用抗抑郁药的患者中，平均连贯性率为86%。多药联合使用抗抑郁药的患者之间或不同抗抑郁药类别之间的连贯性无显著差异。在抗抑郁药使用者中，使用抗抑郁药的连贯性与使用慢性非精神科药物的连贯性无显著差异。在控制了年龄、性别和药物总数等混杂因素后，抗抑郁药使用者在使用慢性非精神科药物方面的连贯性与非抗抑郁药使用者相比无显著降低。
患有内科疾病的持续使用抗抑郁药患者群体在药物使用连贯性方面相当不错，与非抗抑郁药使用者相当。独特的患者群体可能影响了连贯性率。关注持续使用抗抑郁药的患者可能限制了抑郁症对药物治疗连贯性的预期影响。
