US Outcomes Research, Merck & Co., Inc., North Wales, PA, USA.
Health Expect. 2011 Sep;14(3):307-20. doi: 10.1111/j.1369-7625.2010.00619.x. Epub 2010 Sep 23.
OBJECTIVE To identify self-reported reasons why adults with chronic disease do not fill a new prescription (medication non-fulfillment) and/or stop taking a medication without their physician telling them to do so (lack of medication persistence). METHODS Participants were sampled in 2008 from a national, internet-based panel of American adults with chronic disease. A total of 19 830 respondents answered questions about medication non-fulfillment and medication non-persistence and reasons for non-fulfillment and non-persistence. Among persons self-identified as non-fulfillers and non-persisters, statistical analyses assessed the association between reported reasons for non-fulfillment and non-persistence and chronic disease. A subsample of respondents completed an additional survey which included multi-item scales assessing matched constructs of most of the reasons for non-fulfillment and non-persistence. The convergent validity of the self-reported reasons was assessed against the multi-item scales. RESULTS The same four reasons were most commonly reported for both medication non-fulfillment and medication non-persistence: paying for the medication a financial hardship (56 and 43%, respectively); fear or experience of side effects (46 and 35%, respectively); generic concerns about medications (32 and 23%, respectively); and lack of perceived need for the medication (25 and 23%, respectively). The frequency with which the reasons were reported varied somewhat by chronic disease. The convergent validity of most of the self-reported reasons was confirmed against multi-item scales measuring matched constructs. CONCLUSIONS The same top reasons for medication non-fulfillment and non-adherence were observed in a large internet-based sample of American adults with chronic disease. Future efforts to improve medication adherence should address patients' medication concerns, perceived need for medications, and perceived medication affordability.
确定慢性病成年人未按处方取药（药物未使用）和/或在未经医生告知的情况下停止用药（药物持续性差）的自我报告原因。
2008 年，从美国慢性病成年人群体的全国性互联网面板中抽取参与者。共有 19830 名受访者回答了关于药物未使用和药物不持续性以及未使用和不持续性原因的问题。在自我认定为未使用者和不坚持用药者中，统计分析评估了报告的未使用和不持续性原因与慢性病之间的关系。一部分受访者完成了一项额外的调查，其中包括多项评估大多数未使用和不持续性原因的匹配结构的量表。评估了自我报告原因的聚合效度与多项目量表的相关性。
药物未使用和药物不持续性的最常见原因有四个：支付药物费用有经济困难（分别为 56%和 43%）；担心或经历副作用（分别为 46%和 35%）；对药物的普遍担忧（分别为 32%和 23%）；以及缺乏对药物的认知需求（分别为 25%和 23%）。报告这些原因的频率因慢性病而有所不同。大多数自我报告原因与测量匹配结构的多项目量表的聚合效度相符。
在一项针对美国慢性病成年人群体的大型互联网样本中，观察到药物未使用和不依从的相同主要原因。未来改善药物依从性的努力应针对患者的药物顾虑、对药物的认知需求和药物的可负担性。
