van Geffen Erica C G, Heerdink Eiebert R, Hugtenburg Jacqueline G, Siero Frans W, Egberts Antoine C G, van Hulten Rolf
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht.
Int J Pharm Pract. 2010 Aug;18(4):217-25. doi: 10.1111/j.2042-7174.2010.00035.x.
Patients' perceptions are important to consider when trying to understand why patients often do not follow prescriptions for antidepressant treatment. This study aimed to investigate the influence of patients' perceptions and illness severity at the start on antidepressant-medication-taking behaviour.
Eighteen community pharmacies in the Netherlands participated in this 6-month follow-up study. One hundred and ten patients presenting a first antidepressant prescription, prescribed by a general practitioner (GP), were included. A questionnaire was completed at inclusion, after 6 and 26 weeks.
Of all 110 patients, eight (7.3%) did not initiate drug taking, 32 (29.1%) discontinued use, six (5.5%) switched to different antidepressant medication, and 64 (58.2%) continued on the same antidepressant during follow-up. Compared to continuers, non-initiators had lower belief scores for impact of illness (P = 0.044), perceived norm GP (P < 0.001), intention to take medication (P < 0.001), and attitude towards medication (P = 0.004). Furthermore, non-initiators were less severely depressed (P = 0.024). Discontinuers and continuers did not differ in illness severity at inclusion. However, discontinuers more often reported a non-specific reason for use, such as fatigue and sleeping problems (P = 0.014). Compared to continuers, switchers had higher illness severity scores at inclusion (depression, P = 0.041; anxiety, P = 0.050). During follow-up depression and anxiety severity improved for all treatment groups and reached the same level of severity at 6 months.
Patients' illness and treatment perceptions and illness severity influence their decisions about antidepressant drug taking. Patients' care could be improved by eliciting patients' beliefs about illness and treatment and assessing illness severity before prescribing.
在试图理解患者为何常常不遵行抗抑郁治疗处方时，患者的认知是需要考虑的重要因素。本研究旨在调查患者初始时的认知及疾病严重程度对抗抑郁药物服用行为的影响。
荷兰的18家社区药房参与了这项为期6个月的随访研究。纳入了110名由全科医生（GP）开出首张抗抑郁药处方的患者。在纳入时、6周和26周后完成一份问卷。
在所有110名患者中，8名（7.3%）未开始服药，32名（29.1%）停药，6名（5.5%）换用了不同的抗抑郁药物，64名（58.2%）在随访期间继续服用同一种抗抑郁药。与继续服药者相比，未开始服药者在疾病影响信念得分（P = 0.044）、感知到的全科医生规范（P < 0.001）、服药意愿（P < 0.001）以及对药物的态度（P = 0.004）方面较低。此外，未开始服药者的抑郁程度较轻（P = 0.024）。纳入时，停药者和继续服药者的疾病严重程度无差异。然而，停药者更常报告使用药物的非特异性原因，如疲劳和睡眠问题（P = 0.014）。与继续服药者相比，换用药物者在纳入时的疾病严重程度得分较高（抑郁，P = 0.041；焦虑，P = 0.050）。在随访期间，所有治疗组的抑郁和焦虑严重程度均有所改善，并在6个月时达到相同的严重程度水平。
患者对疾病和治疗的认知以及疾病严重程度会影响他们对抗抑郁药物服用的决策。通过在开处方前了解患者对疾病和治疗的信念并评估疾病严重程度，可改善患者的护理。
