Liu-Seifert Hong, Adams David H, Ascher-Svanum Haya, Faries Douglas E, Kinon Bruce J
Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
Patient Prefer Adherence. 2007 Dec 20;1:9-17.
The objective of this study was to examine the relationship between patient beliefs about medication use and their likelihood of discontinuing treatment prematurely. Associations of patient beliefs about medication with clinical psychopathology and their life satisfaction were also assessed.
This post-hoc analysis used data from a randomized, open label, 1-year trial of antipsychotics in the treatment of patients with schizophrenia or schizoaffective disorders (N = 664). Medication management including dosage adjustment and medication switching was at doctors' discretion, reflecting naturalistic treatment in usual clinical care settings. Early treatment discontinuation was defined as all-cause study drop out. Patient-reported beliefs about medication were assessed by Rating of Medication Influences (ROMI), degree of clinical psychopathology was measured by Positive and Negative Syndrome Scale (PANSS), and patient quality of life was measured by Lehman Quality of Life Interview (LQLI).
Patient perception of medication benefit was the only strong predictor of treatment duration among the 5 underlying dimensions of medication influence. Higher level of perceived beneficial effect of medication was associated with reduced risk of early treatment discontinuation (Hazard ratio = 0.56, 95% Confidence Interval [0.40, 0.79], p = 0.001). Patients with greater beliefs in the beneficial effect of treatment also had better clinical psychopathology outcome and were more satisfied with their quality of life and well-being.
Understanding the predictors of early treatment discontinuation in the care of schizophrenia patients is important for the development of interventions to improve treatment outcome. Current findings suggest that patient perception of beneficial effect of medication may be a critical factor in achieving treatment persistence and a satisfactory treatment outcome.
本研究的目的是探讨患者对药物治疗的信念与其过早停药可能性之间的关系。还评估了患者对药物的信念与临床精神病理学及其生活满意度之间的关联。
这项事后分析使用了一项随机、开放标签、为期1年的抗精神病药物治疗精神分裂症或分裂情感性障碍患者试验（N = 664）的数据。药物管理包括剂量调整和换药由医生自行决定，反映了常规临床护理环境中的自然治疗情况。早期治疗中断定义为因各种原因退出研究。通过药物影响评分（ROMI）评估患者报告的对药物的信念，通过阳性和阴性症状量表（PANSS）测量临床精神病理学程度，通过雷曼生活质量访谈（LQLI）测量患者生活质量。
在药物影响的5个潜在维度中，患者对药物益处的认知是治疗持续时间的唯一强预测因素。较高水平的药物感知有益效果与早期治疗中断风险降低相关（风险比 = 0.56，95%置信区间[0.40, 0.79]，p = 0.001）。对治疗有益效果信念更强的患者临床精神病理学结果也更好，对生活质量和幸福感更满意。
了解精神分裂症患者护理中早期治疗中断的预测因素对于开发改善治疗结果的干预措施很重要。当前研究结果表明，患者对药物有益效果的认知可能是实现治疗持续性和满意治疗结果的关键因素。
