Medco Health Solutions, Inc., Franklin Lakes, NJ, USA.
J Affect Disord. 2011 Apr;130(1-2):46-52. doi: 10.1016/j.jad.2010.09.018. Epub 2010 Oct 14.
Non-adherence to antidepressant medications is a contributing factor to disease relapse and may result in needless increases in antidepressant dosing.
We analyzed de-identified patient claims data from Medco Health Solutions, Inc.'s information database and measured adherence as the medication possession ratio (MPR), with adequate adherence as MPR ≥80%. Adherence was calculated for patients in whom antidepressants were dose escalated and who were on the same antidepressant medication for at least 180 days before the upward dosage titration. Statistical analysis was performed on subgroups comparing adherence with mail vs. retail channels, differences in age and gender, generic prescription vs. brand only, and prescription by psychiatrist vs. non-psychiatrist.
29.7% of patients were non-adherent to their antidepressant medication during the 6 months prior to a prescribed increase in dosage. Non-adherence was significantly lower among patients using the Medco Therapeutic Resource Centers® mail order vs. retail channel. Younger age correlated with poorer adherence. Rates of non-adherence were also significantly greater among women, those receiving generic medications, and among patients with overall lower disease comorbidity. Adherence was not significantly impacted by prescription from a psychiatrist or a non-psychiatrist.
Retrospective design and use of an administrative patient claims database.
Suboptimal medication adherence commonly precedes an upward dosage titration of antidepressant medications. Utilization of a mail order channel may improve adherence. Clinicians prescribing antidepressants should explore adherence issues carefully prior to recommending an increase in dosage.
抗抑郁药物治疗不依从是导致疾病复发的一个因素，可能导致不必要地增加抗抑郁药物剂量。
我们分析了 Medco Health Solutions, Inc. 信息数据库中的去标识患者索赔数据，并将药物占有率（MPR）作为依从性的衡量标准，足够的依从性定义为 MPR≥80%。对于接受抗抑郁药物剂量递增且在向上剂量滴定前至少使用相同抗抑郁药物 180 天的患者，计算了其依从性。通过比较邮件与零售渠道、年龄和性别差异、仅使用仿制药与仅使用品牌药、精神科医生处方与非精神科医生处方的亚组，进行了统计学分析。
在剂量递增前的 6 个月内，29.7%的患者对抗抑郁药物不依从。使用 Medco Therapeutic Resource Centers®邮购与零售渠道的患者，不依从的比例显著降低。年龄较小与依从性较差相关。女性、使用仿制药以及整体疾病共病率较低的患者，不依从的比例也显著更高。处方医生是否为精神科医生对依从性没有显著影响。
回顾性设计和使用行政患者索赔数据库。
抗抑郁药物剂量递增前通常存在药物治疗依从性不佳的情况。使用邮购渠道可能会提高依从性。开抗抑郁药的临床医生在建议增加剂量前，应仔细探讨依从性问题。
