Merck & Co., Inc., North Wales, PA, USA.
Curr Med Res Opin. 2010 Mar;26(3):683-705. doi: 10.1185/03007990903550586.
The literature on nonfulfillment of prescription medications spans over three decades of work. There is a wide variation in reported nonfulfillment rates, but no previous study has systematically reviewed this literature to explore the reasons behind this variation.
The objective of this study was to review estimates of medication nonfulfillment rates and published reasons for nonfulfillment and explore whether nonfulfillment rates vary by study variables.
Articles were identified through searches conducted on MEDLINE, CINAHL, Psych Info, and EMBASE, and review of relevant reference citations. Methodological variables, nonfulfillment rate, and unit of analysis (i.e., patient or prescription) were abstracted from each article selected for review. Mean and median nonfulfillment rates for groups categorized by unit of analysis and selected methodological variables (method for assessing nonfulfillment, sample characteristics, disease subgroup, sample size, country of data collection, recall period or time allowed before classifying as nonfulfillment, and year of study) were calculated. Reasons for nonfulfillment were abstracted from all articles that included a relevant discussion.
A total of 79 studies reporting pure nonfulfillment rates (59 at the patient level and 20 at the prescription level) and six studies reporting nonfulfillment rates in combination with nonpersistence rates were included. There was a wide variation in nonfulfillment rates reported by the studies - from 0.5% to 57.1%. The three primary reasons for nonfulfillment identified from this review were perceived concerns about medications, lack of perceived need for medications, and medication affordability issues.
To the best of the authors' knowledge, this study is the first narrative systematic review on nonfulfillment of prescription medications. Despite the wide variation in individual study rates, the mean and median rates across different modes of data collection and sources of data were in a relatively narrow range (11% to 19%) and surprisingly close to the overall mean (16.4%) and median (15%.0) rates for all studies. The reasons for nonfulfillment identified through this review address barriers to nonfulfillment at the patient, physician, and health system level and thus bear important implications for policy makers.
关于处方药不使用的文献已经有三十多年的研究历史了。报告的不使用率差异很大，但以前没有研究系统地综述过这方面的文献，以探讨这种差异的原因。
本研究旨在综述药物不使用率的估计值和已发表的不使用原因，并探讨不使用率是否因研究变量而有所不同。
通过在 MEDLINE、CINAHL、PsychInfo 和 EMBASE 上进行检索，并查阅相关参考文献，确定了文章。从每个被选择进行综述的文章中提取方法学变量、不使用率和分析单位（即患者或处方）。按分析单位和选定的方法学变量（评估不使用的方法、样本特征、疾病亚组、样本量、数据收集的国家、在将其归类为不使用之前的回忆期或允许时间以及研究年份）对分组的组计算平均和中位数不使用率。从所有包含相关讨论的文章中提取不使用的原因。
共纳入 79 项报告纯不使用率的研究（59 项为患者水平，20 项为处方水平）和 6 项报告不使用率与不持续性率相结合的研究。研究报告的不使用率差异很大，从 0.5%到 57.1%。从本综述中确定的不使用的三个主要原因是对药物的担忧、对药物的需求感知不足和药物的可负担性问题。
据作者所知，这是第一项关于处方药不使用的叙述性系统综述。尽管个别研究的速率差异很大，但在不同数据收集模式和数据来源下的平均值和中位数率都在一个相对较窄的范围内（11%至 19%），与所有研究的总体平均值（16.4%）和中位数（15.0%）非常接近。本综述中确定的不使用原因涉及患者、医生和医疗系统层面的不使用障碍，因此对政策制定者具有重要意义。
