Department of Mental Health, Seoul National Hospital, Seoul, Korea.
Psychosom Med. 2010 Jan;72(1):80-7. doi: 10.1097/PSY.0b013e3181c4e3e9. Epub 2009 Nov 20.
To identify the relationship between various types of psychiatric disorders and adherence to antihypertensive medication.
We obtained data from claims submitted to the National Health Insurance, which covers almost the entire Korean population. Of the total of 2,454,844 patients who received prescriptions for antihypertensive medication during 2004, the study used data from 158,982 patients diagnosed with psychiatric disorders and 2,295,862 patients without psychiatric disorders according to International Classification of Diseases 10th Revision. We measured cumulative medication adherence (CMA) and compared the rates of appropriate level of adherence, defined as CMA > or =80%, between individuals with and without psychiatric disorders. We used multiple logistic regression to identify differences in antihypertensive medication adherence according to the type of psychiatric disorder.
Adherence to antihypertensive medication regimens was lower among patients with dementia, alcohol use disorders, psychotic disorders, and mood disorders-accounting for 15.4% of the patients with psychiatric disorders. On the other hand, the majority of patients (82.8%) who had substance use disorders, anxiety disorders, neurotic and somatoform disorders, and behavioral syndromes showed greater adherence. Overall adherence was higher in those with psychiatric disorders than in those without psychiatric disorders after adjusting for sociodemographic and clinical factors (odds ratio = 1.03, 95% Confidence Interval = 1.02-1.04).
Adherence to medication is reduced in patients with various types of psychiatric disorders, usually those accompanied by functional impairment. Effective strategies for improving medication adherence should be tailored to individual levels of function and psychopathology.
确定各种精神障碍与抗高血压药物治疗依从性之间的关系。
我们从提交给国家健康保险的索赔中获取数据，该保险涵盖了几乎所有韩国人口。在 2004 年接受抗高血压药物治疗处方的 2454844 名患者中，该研究根据国际疾病分类第 10 版，使用了 158982 名被诊断患有精神障碍和 2295862 名没有精神障碍的患者的数据。我们测量了累积药物依从性（CMA），并比较了有和没有精神障碍的个体之间适当水平的依从率，定义为 CMA≥80%。我们使用多变量逻辑回归来确定根据精神障碍类型的抗高血压药物治疗依从性的差异。
痴呆、酒精使用障碍、精神病性障碍和心境障碍患者的抗高血压药物治疗方案依从性较低，占精神障碍患者的 15.4%。另一方面，大多数（82.8%）患有物质使用障碍、焦虑障碍、神经症和躯体形式障碍以及行为综合征的患者表现出更高的依从性。在调整了社会人口统计学和临床因素后，总体而言，患有精神障碍的患者比没有精神障碍的患者的药物治疗依从性更高（比值比=1.03，95%置信区间=1.02-1.04）。
各种类型的精神障碍患者的药物治疗依从性降低，通常是那些伴有功能障碍的患者。改善药物治疗依从性的有效策略应根据个体的功能和精神病理学水平进行调整。
