Schousboe J T, Dowd B E, Davison M L, Kane R L
Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Osteoporos Int. 2010 Nov;21(11):1899-909. doi: 10.1007/s00198-009-1141-5. Epub 2009 Dec 5.
Our objective was to assess the association of self-reported non-persistence (stopping fracture-prevention medication for more than 1 month) and self-reported non-compliance (missing doses of prescribed medication) with perceived need for fracture-prevention medication, concerns regarding long-term harm from and/or dependence upon medications, and medication-use self-efficacy (confidence in one's ability to successfully take medication in the context of their daily life).
Non-persistence (stopping medication prematurely) and non-compliance (not taking medications at the prescribed times) with oral medications to prevent osteoporotic fractures is widespread and attenuates their fracture reduction benefit.
Cross-sectional survey and medical record review of 729 patients at a large multispecialty clinic in the United States prescribed an oral bisphosphonate between January 1, 2006 and March 31, 2007.
Low perceived necessity for fracture-prevention medication was strongly associated with non-persistence independent of other predictors, but not with non-compliance. Concerns about medications were associated with non-persistence, but not with non-compliance. Low medication-use self-efficacy was associated with non-persistence and non-compliance.
Non-persistence and non-compliance with oral bisphosphonate medication have different, albeit overlapping, sets of predictors. Low perceived necessity of fracture-prevention medication, high concerns about long-term safety of and dependence upon medication , and low medication-use self-efficacy all predict non-persistence with oral bisphosphonates, whereas low medication-use self-efficacy strongly predicts non-compliance with oral bisphosphonate medication. Assessment of and influence of these medication attitudes among patients at high risk of fracture are likely necessary to achieve better persistence and compliance with fracture-prevention therapies.
我们的目标是评估自我报告的停药（停止使用预防骨折药物超过1个月）和自我报告的不依从（漏服处方药）与对预防骨折药物的感知需求、对药物长期危害和/或药物依赖的担忧以及药物使用自我效能感（对自己在日常生活中成功服药能力的信心）之间的关联。
口服预防骨质疏松性骨折药物时的停药（过早停药）和不依从（未按规定时间服药）现象普遍存在，会削弱这些药物的骨折预防效果。
对美国一家大型多专科诊所的729例患者进行横断面调查和病历回顾，这些患者在2006年1月1日至2007年3月31日期间被处方口服双膦酸盐药物。
对预防骨折药物的低感知必要性与停药密切相关，独立于其他预测因素，但与不依从无关。对药物的担忧与停药有关，但与不依从无关。低药物使用自我效能感与停药和不依从有关。
口服双膦酸盐药物的停药和不依从有不同但部分重叠的预测因素集。对预防骨折药物的低感知必要性、对药物长期安全性和依赖性的高度担忧以及低药物使用自我效能感均预测口服双膦酸盐药物的停药情况，而低药物使用自我效能感强烈预测口服双膦酸盐药物的不依从情况。为了更好地坚持和依从骨折预防治疗，可能有必要评估并影响这些骨折高危患者的用药态度。
