Barbui Corrado, Kikkert Martijn, Mazzi Maria Angela, Becker Thomas, Bindman Jonathan, Schene Aart, Nosè Michela, Helm Hedda, Thornicroft Graham, Tansella Michele
Section of Psychiatry and Clinical Psychology,Department of Medicine and Public Health, University of Verona, Verona, Italy.
Psychopathology. 2009;42(5):311-7. doi: 10.1159/000232973. Epub 2009 Aug 11.
Factors influencing patient and clinician perspectives in the assessment of medication adherence have never been compared.
This study used baseline and 12-month follow-up data from the QUATRO study, an international multicentre study. At baseline, information on patient sociodemographic characteristics, treatment factors, psychopathology, functioning and experience of antipsychotic side effects was gathered. After 12 months of follow-up, psychopathology, functioning and patient experience of antipsychotic side effects were measured once more, and a patient and clinician rating of adherence was obtained by means of the Medication Adherence Rating Scale (MARS) and the Compliance Rating Scale (CRS).
During the recruitment period, 409 subjects with a diagnosis of schizophrenia were recruited. Patients were more often men and single. Mean age was 41.5 years. At the time of the assessment, more than 40% were unemployed and on average had been on antipsychotic treatment for more than 10 years. Nearly 70% were receiving second-generation antipsychotics, and 50% received adherence therapy during the 12 months after enrollment. The relationship between the MARS and the CRS scores showed only a small overlap (correlation coefficient = 0.26). In the multivariate model, the only factor significantly associated with both patient and clinician ratings of adherence was psychopathology. Unemployment and poor subjective tolerability of antipsychotics were significantly associated with low levels of patient ratings of adherence. Conversely, length of treatments and use of newer antipsychotics were significantly associated with better clinician ratings of adherence.
Patient and clinician ratings of adherence do not measure the same dimension. Factors that may positively affect adherence in terms of compliance with prescribed medication regimens may not affect patients' views on adherence, and this should be taken into consideration when planning and negotiating treatment modalities with each individual patient suffering from schizophrenia.
在药物依从性评估中影响患者和临床医生观点的因素从未被比较过。
本研究使用了来自国际多中心研究QUATRO研究的基线和12个月随访数据。在基线时，收集了患者的社会人口学特征、治疗因素、精神病理学、功能以及抗精神病药物副作用经历等信息。随访12个月后，再次测量精神病理学、功能以及抗精神病药物副作用的患者经历，并通过药物依从性评定量表（MARS）和依从性评定量表（CRS）获得患者和临床医生的依从性评分。
在招募期间，招募了409名诊断为精神分裂症的受试者。患者中男性和单身者更为常见。平均年龄为41.5岁。在评估时，超过40%的人失业，平均接受抗精神病治疗超过10年。近70%的人正在接受第二代抗精神病药物治疗，50%的人在入组后的12个月内接受了依从性治疗。MARS和CRS评分之间的关系仅显示出很小的重叠（相关系数 = 0.26）。在多变量模型中，与患者和临床医生依从性评分均显著相关的唯一因素是精神病理学。失业和抗精神病药物的主观耐受性差与患者依从性评分低显著相关。相反，治疗时间和使用新型抗精神病药物与临床医生更高的依从性评分显著相关。
患者和临床医生的依从性评分衡量的不是同一维度。在遵守规定药物治疗方案方面可能对依从性有积极影响的因素可能不会影响患者对依从性的看法，在为每位精神分裂症患者规划和协商治疗方式时应考虑到这一点。
