Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands.
Ann Pharmacother. 2010 Nov;44(11):1755-61. doi: 10.1345/aph.1P162. Epub 2010 Oct 12.
In daily practice, treatment adherence and persistence (duration) have mainly been investigated using large administrative databases. However, patients rarely collect a subsequent prescription on the day that the last dose has been consumed from the prior prescription. Therefore, the drug treatment patterns constructed from prescribing or dispensing moments in administrative databases can seem irregular, while patients in the real-world setting continue drug taking without gaps or overlaps in their drug use.
To investigate whether patient-reported drug taking concurs with length of gaps and overlaps seen in an antidepressant dispensing database.
Questionnaires on drug taking were sent from Dutch pharmacies to patients using second-generation antidepressants during September-December 2008. Gaps and overlaps between subsequently dispensed prescriptions were investigated. Patients with a gap/overlap were divided into 3 subgroups based on gap/overlap magnitude (<5% of total observed treatment time; gap/overlap ≥5% but <20% of total observed time; ≥20% of total observed treatment time) and compared for patient-reported drug taking.
The study population (N = 205) was predominantly female (62.9%), with a mean ± SD age of 48.0 ± 13.6 years. About 71% of the subjects had a gap, 27% had an overlap, and 2% had no gap/overlap between dispensing moments. Patients with a gap ≥20% reported nonadherent behavior more often (p < 0.01) than patients with shorter gaps. No significant differences in reported adherence were found between patients with different overlap magnitudes. Patients with a gap of ≥20% were the least likely to inform their physician or pharmacist about using their medication differently from label instructions.
Patients with larger dispensing gaps more frequently report that they have skipped a dose, changed their dose, or used less medication than instructed. Dispensing gaps do not necessarily indicate that the medicine is not used on gap days. More research is needed to investigate the validity of dispensing patterns and their correlation with drug taking in the real-world setting.
在日常实践中，主要通过大型管理数据库研究治疗依从性和持续性（持续时间）。然而，患者很少在最后一次剂量消耗完前一次处方的当天就再次取药。因此，从管理数据库中的配药或发药时刻构建的药物治疗模式可能看起来不规则，而现实世界中患者在继续服药时不会出现药物使用的中断或重叠。
调查患者报告的药物使用情况是否与抗抑郁药配药数据库中观察到的间隙和重叠长度相符。
2008 年 9 月至 12 月，荷兰各药店向使用第二代抗抑郁药的患者发送了关于药物使用情况的调查问卷。调查了随后配药之间的间隙和重叠情况。根据间隙/重叠幅度将有间隙/重叠的患者分为 3 个亚组（<总观察治疗时间的 5%；间隙/重叠≥5%但<20%的总观察时间；≥20%的总观察治疗时间），并比较患者报告的药物使用情况。
研究人群（N=205）主要为女性（62.9%），平均年龄±标准差为 48.0±13.6 岁。约 71%的患者有间隙，27%的患者有重叠，2%的患者在配药时刻之间没有间隙/重叠。有≥20%的间隙的患者更经常报告不遵医嘱行为（p<0.01），而间隙较短的患者则较少报告不遵医嘱行为。在不同重叠幅度的患者中，报告的依从性没有显著差异。有≥20%的间隙的患者最不可能告知医生或药剂师他们的用药方式与标签说明不同。
间隙较大的患者更频繁地报告漏服、改变剂量或使用少于医嘱的药物。配药间隙并不一定表明在间隙日没有使用药物。需要进一步研究来调查现实环境中配药模式的有效性及其与药物使用的相关性。
