Health Metrics Outcomes Research, Groton, CT, USA.
Ann Gen Psychiatry. 2009 Feb 18;8:7. doi: 10.1186/1744-859X-8-7.
Reducing hospitalizations and emergency room visits is important to improve patient outcomes. This observational study examined the association between adherence to antipsychotics and risk of hospitalizations and emergency room (ER) visits among patients with bipolar disorder.
Claims data from commercial healthcare plans (Pharmetrics; January 2000 to December 2006) for patients with bipolar disorder receiving an antipsychotic prescription were examined. Adherence was analyzed over a 12-month follow-up period after the receipt of first prescription of an antipsychotic. Adherence to antipsychotics was measured by the medication possession ratio (MPR). The MPR was calculated as the number of days that an antipsychotic medication was filled as compared with the total number of days during the follow-up period. Logistic stepwise regressions examined the association between achievement of various adherence goals and patient outcomes (hospitalization or ER visit for mental health or any reason).
In total, 7,769 patients with bipolar disorder were included. The mean MPR was 0.417, with 61.7% of individuals having an MPR < 0.50, and 78.7% an MPR < 0.75. As adherence improved, the risk of hospitalization or ER visit declined. A significant reduction in the risk of hospitalization (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.75 to 0.98) or an ER visit (OR 0.84, 95% CI 0.74 to 0.96) for any cause was associated with an MPR >or= 0.75. An MPR >or= 0.80 was associated with a significant reduction in the risk of a mental health-related hospitalization (OR 0.82, 95% CI 0.70 to 0.95), while an MPR >or= 0.90 was associated with a significant reduction in risk of a mental health-related ER visit (OR 0.71, 95% CI 0.54 to 0.91).
Patients with lower antipsychotic adherence were at greater risk of hospitalizations and ER visits. Thus, any efforts to increase adherence, even in small increments, can be helpful in decreasing these risks.
减少住院和急诊就诊次数对于改善患者预后很重要。这项观察性研究考察了双相障碍患者服用抗精神病药物的依从性与住院和急诊就诊风险之间的关联。
研究使用商业医保计划的理赔数据（Pharmetrics，2000 年 1 月至 2006 年 12 月），纳入接受抗精神病药物处方的双相障碍患者。在首次开出处方后的 12 个月随访期间分析患者的依从性。以药物使用比例（MPR）衡量抗精神病药物的依从性。MPR 计算方法为服用抗精神病药物的天数与随访期间总天数之比。采用逻辑逐步回归分析考察了实现不同依从性目标与患者结局（因精神健康或其他任何原因住院或急诊就诊）之间的关联。
共有 7769 例双相障碍患者纳入研究。平均 MPR 为 0.417，61.7%的患者 MPR＜0.50，78.7%的患者 MPR＜0.75。随着依从性的提高，住院或急诊就诊的风险降低。MPR≥0.75 与住院（比值比（OR）0.85，95%置信区间（CI）0.75 至 0.98）或因任何原因急诊就诊（OR 0.84，95%CI 0.74 至 0.96）的风险显著降低相关。MPR≥0.80 与精神健康相关住院风险显著降低相关（OR 0.82，95%CI 0.70 至 0.95），而 MPR≥0.90 与精神健康相关急诊就诊风险显著降低相关（OR 0.71，95%CI 0.54 至 0.91）。
抗精神病药物依从性较低的患者住院和急诊就诊的风险更高。因此，任何增加依从性的努力，即使只是略有增加，都有助于降低这些风险。
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