National Capitol Consortium Fellowship in Female Pelvic Medicine and Reconstruction, Walter Reed Army Medical Center, Washington, DC, USA.
J Urol. 2010 Mar;183(3):1077-81. doi: 10.1016/j.juro.2009.11.026. Epub 2010 Jan 21.
We examined overactive bladder medication compliance in a health care system in which patients do not pay for medication.
Pharmacy dispensing records were reviewed for antimuscarinic agents from January 2003 to December 2006 for the United States Military Health System National Capital Region. Medication nonpersistence, switching and adherence were examined. Kaplan-Meier survival analysis was done to compare medication persistence duration.
Overactive bladder medications were dispensed to 7,879 adults. Tolterodine extended release (4,716 patients or 60%) and oxybutynin immediate release (2,003 or 25.5%) were most commonly prescribed. The medication nonpersistence rate, defined as the proportion of patients who never refilled a prescription for antimuscarinics during the study period, was 35.1% (2,760 of 7,858). Of 5,098 patients who refilled a prescription 1,305 changed the medication or dose at least once for a medication switch rate of 25.6%. The overall median medication possession ratio, defined as the total days of medication dispensed except for the last refill divided by the number of days between the first dispense date and the last refill date, was 0.82 in all cases. Men had a significantly higher median medication possession ratio than women (0.86 vs 0.81, p <0.001). Of patients who obtained at least 1 refill women remained on medication longer than men (median 606 vs 547 days, p = 0.01). Patients on tolterodine extended release had a higher medication nonpersistence rate than those on oxybutynin immediate release (0.89 vs 0.68, p <0.01). There was no difference between extended release medications.
In a health care system in which patients do not pay for medications 35% of patients did not refill a prescription for overactive bladder medication, similar to previous reports. However, other measures of medication compliance were higher than those published previously in systems with copays.
我们研究了在一个患者无需支付药物费用的医疗体系中，治疗膀胱过度活动症的药物的依从性。
回顾了 2003 年 1 月至 2006 年 12 月美国国家首都地区军事医疗系统的抗毒蕈碱药物的药房配药记录。考察了药物不持续使用、转换和遵从情况。采用 Kaplan-Meier 生存分析比较药物持续时间。
7879 名成年人开了治疗膀胱过度活动症的药物。托特罗定缓释剂（4716 名患者，60%）和奥昔布宁即时释放剂（2003 名，25.5%）是最常开的处方。药物不持续使用率定义为研究期间从未重新开抗毒蕈碱药物处方的患者比例，为 35.1%（2760/7858）。在 5098 名重新开处方的患者中，有 1305 名患者至少换过一次药物或剂量，转换率为 25.6%。所有情况下的总体药物持有率中位数（定义为除最后一次配药外的总配药天数除以首次配药日期和最后一次配药日期之间的天数）为 0.82。男性的药物持有率中位数显著高于女性（0.86 对 0.81，p<0.001）。至少开了一次药的患者中，女性继续用药的时间长于男性（中位数 606 对 547 天，p=0.01）。服用托特罗定缓释剂的患者药物不持续使用的比例高于服用奥昔布宁即时释放剂的患者（0.89 对 0.68，p<0.01）。缓释药物之间没有差异。
在一个患者无需支付药物费用的医疗体系中，35%的患者没有重新开治疗膀胱过度活动症的药物处方，这与之前的报告相似。然而，其他药物依从性指标高于之前在有共付额的系统中发表的指标。
