Hassan Mariam, Lage Maureen J
Health Economics and Outcomes Research, AstraZeneca Pharmaceuticals LP, Wilmington, DE 19850, USA.
Am J Health Syst Pharm. 2009 Feb 15;66(4):358-65. doi: 10.2146/ajhp080374.
The relationship between nonadherence to antipsychotic medication after hospital discharge and risk of rehospitalization in patients who were previously hospitalized for treatment of bipolar disorder was studied.
Administrative claims data from 2000 through 2006 were obtained from commercial insurance plans. Patients age 18-64 years who were discharged from a hospital with a diagnosis of bipolar disorder and given a prescription for an antipsychotic 0-14 days after discharge comprised the study sample. Adherence to antipsychotic medication was determined by measuring the number of unique days during which medication was supplied during the treatment period, a calculation known as the medication possession ratio (MPR). Rehospitalization was considered to be an indicator of relapse. A multivariate, stepwise logistic regression, which controlled for patient characteristics, type of bipolar disorder, general health status, and comorbid conditions, was used to assess the relationship between medication non-adherence and rehospitalization.
A total of 1973 individuals were included in the analyses. The mean +/- S.D. MPR for this patient population was 0.46 +/- 0.32. Patients whose MPR was 0.75 or greater had a lower risk of all-cause rehospitalization (odds ratio [OR], 0.730; 95% confidence interval [CI], 0.580-0.919) and a lower risk of a mental-health-related rehospitalization (OR, 0.759; 95% CI, 0.603-0.955). As medication adherence increased above the MPR of 0.75, the risk of rehospitalization significantly decreased.
Among patients who were previously hospitalized for treatment of bipolar disorder, those who were adherent to their antipsychotic medication at least 75% of the time had lower risks of all-cause rehospitalization and mental-health-related rehospitalization.
研究双相情感障碍患者出院后抗精神病药物治疗依从性与再住院风险之间的关系。
从商业保险计划中获取2000年至2006年的行政索赔数据。研究样本包括年龄在18 - 64岁之间、因双相情感障碍出院且出院后0 - 14天开具抗精神病药物处方的患者。通过测量治疗期间提供药物的独特天数来确定抗精神病药物的依从性，这一计算方法称为药物持有率（MPR）。再住院被视为复发的指标。采用多变量逐步逻辑回归分析，控制患者特征、双相情感障碍类型、总体健康状况和合并症，以评估药物不依从与再住院之间的关系。
共有1973名个体纳入分析。该患者群体的平均MPR为0.46±0.32。MPR为0.75或更高的患者全因再住院风险较低（优势比[OR]，0.730；95%置信区间[CI]，0.580 - 0.919），心理健康相关再住院风险较低（OR，0.759；95%CI，0.603 - 0.955）。随着药物依从性超过MPR 0.75，再住院风险显著降低。
在先前因双相情感障碍住院治疗的患者中，那些至少75%的时间坚持服用抗精神病药物的患者全因再住院和心理健康相关再住院风险较低。
