Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), 7400 Merton Minter Boulevard, San Antonio, TX 78229-4404, USA.
Adm Policy Ment Health. 2011 Mar;38(2):86-95. doi: 10.1007/s10488-010-0304-1.
Medication adherence is critical for patients with bipolar disorder to avoid symptom exacerbation and diminished quality of life. Most analyses consider adherence barriers individually rather than conjointly, while neglecting potential ethnic differences. 435 patients in the Continuous Improvement for Veterans in Care--Mood Disorders study reported multiple financial and psychosocial factors influencing adherence. Logistic regression modeled adherence as a function of perceived barriers, including cost burden, access, binge drinking, poor therapeutic alliance, and medication beliefs. Nearly half the cohort experienced adherence difficulty, averaging 2.8 barriers, with minority veterans reporting lower adherence than white patients, particularly financial burden and treatment access. Total barriers were significantly associated with worse adherence (OR = 1.24 per barrier), notably poor medication beliefs, binge drinking, and difficulty accessing psychiatric specialists (ORs of 2.41, 1.95 and 1.73, respectively). Veterans with bipolar disorder experience numerous adherence barriers, with certain obstacles proving especially pernicious. Fortunately tailored clinical interventions can improve adherence, particularly by addressing modifiable risk factors.
药物依从性对于双相情感障碍患者避免症状恶化和生活质量下降至关重要。大多数分析单独考虑药物依从性障碍，而不是综合考虑，同时忽略了潜在的种族差异。在 Veterans in Care--Mood Disorders 研究中，有 435 名患者报告了多种影响药物依从性的经济和心理社会因素。逻辑回归模型将药物依从性作为感知障碍的函数，包括经济负担、获取途径、狂饮、不良治疗联盟和药物信念。近一半的患者报告存在药物依从性困难，平均有 2.8 个障碍，少数民族退伍军人的药物依从性比白人患者差，特别是经济负担和治疗途径。总的障碍与较差的药物依从性显著相关（每增加一个障碍，OR 值增加 1.24），特别是不良的药物信念、狂饮和难以获得精神科专家的治疗（OR 值分别为 2.41、1.95 和 1.73）。患有双相情感障碍的退伍军人面临着许多药物依从性障碍，某些障碍尤其严重。幸运的是，量身定制的临床干预可以改善药物依从性，特别是通过解决可改变的风险因素。
