i3 Innovus, Eden Prairie, MN, USA.
Curr Med Res Opin. 2010 Apr;26(4):777-85. doi: 10.1185/03007990903579171.
This study explored physicians' perceptions of patient adherence to medications compared with patient adherence derived by administrative data in the treatment of osteoporosis.
A study involving written questionnaires from prescribers treating patients with postmenopausal osteoporosis (PMO) compared the questionnaire responses to pharmacy claims of these prescribers' patients' refill patterns. Approximately 2000 physicians from a large US health plan were faxed or mailed a survey. Data from the physician survey were merged with administrative claims data of the participating physicians' patients.
A total of 412 physicians (21.8%) responded. Although a low response rate, there were no significant demographic differences between participating and non-participating physicians. Surveyed physicians reported that 66% of their patients had private/commercial coverage and over 60% reported seeing their PMO patients annually. Overall, physicians estimated that 69.2% of patients were adherent 80% of the time after 12 months of therapy. Yet, pharmacy claims data for those physicians' patients indicated 48.7% of patients were adherent (defined as having an MPR of >or=80%) after 12 months of therapy. Physicians overestimated their patients' adherence regardless of medication class and across physician specialties. Regression modeling revealed that physicians who have been in practice longer estimated fewer patients as adherent, whereas those who prescribe more PMO treatments estimate a greater number of patients as adherent. Providers cited side effects and affordability of medication as the most frequent reasons for non-adherence.
Physicians overestimate patient adherence to PMO therapies. Improving physician awareness of medication non-adherence to PMO therapies may facilitate physician-patient dialogue, with the aim of identifying patient-centered reasons for non-adherence. These discussions are important because patients with poorer adherence have a higher risk of fracture. Future research should focus on reasons for patient non-adherence to osteoporosis regimens and intervention strategies that improve communication between the provider and patient. Findings must be considered within the limitations of this claims database analysis. Some degree of incomplete or incorrect coding may exist, and the presence of a claim for a filled prescription does not indicate that the medication was consumed or taken as prescribed. Patients included in the study are not necessarily representative of all patients being treated for osteoporosis.
本研究探讨了医生对患者药物依从性的看法与骨质疏松症治疗中通过行政数据得出的患者依从性之间的差异。
本研究涉及对治疗绝经后骨质疏松症（PMO）的医生进行书面问卷调查，比较了这些医生的患者的药物补充模式的问卷回答与药房配药记录。一家大型美国医疗保健计划向大约 2000 名医生发送了传真或邮寄了调查问卷。参与医生的行政索赔数据与医生的调查数据相合并。
共有 412 名医生（21.8%）做出了回应。尽管回应率较低，但参与和不参与的医生在人口统计学方面没有显著差异。接受调查的医生报告称，他们的 66%的患者拥有私人/商业保险，超过 60%的医生报告称每年都会见到他们的 PMO 患者。总体而言，医生估计在 12 个月的治疗后，69.2%的患者有 80%的时间是依从治疗的。然而，这些医生的患者的配药数据显示，在 12 个月的治疗后，有 48.7%的患者是依从的（定义为 MPR ＞或=80%）。无论药物类别如何，以及跨越医生的专业领域，医生对其患者的依从性的估计都偏高。回归模型显示，行医时间较长的医生估计的依从性患者较少，而开具更多 PMO 治疗药物的医生则估计有更多的患者是依从的。提供者将药物副作用和药物可负担性列为最常见的不依从原因。
医生高估了 PMO 治疗的患者依从性。提高医生对 PMO 治疗药物不依从性的认识，可能有助于促进医患对话，目的是确定以患者为中心的不依从原因。这些讨论很重要，因为依从性较差的患者骨折风险更高。未来的研究应重点关注骨质疏松症治疗方案中患者不依从的原因以及改善提供者与患者之间沟通的干预策略。在考虑这项索赔数据库分析的局限性的前提下，必须对研究结果进行分析。可能存在某种程度的不完整或不正确的编码，并且有处方配药记录并不表示药物已被消耗或按规定服用。纳入研究的患者不一定代表所有接受骨质疏松症治疗的患者。
