Department of Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.
Annu Rev Pharmacol Toxicol. 2012;52:275-301. doi: 10.1146/annurev-pharmtox-011711-113247. Epub 2011 Sep 19.
Satisfactory adherence to aptly prescribed medications is essential for good outcomes of patient care and reliable evaluation of competing modes of drug treatment. The measure of satisfactory adherence is a dosing history that includes timely initiation of dosing plus punctual and persistent execution of the dosing regimen throughout the specified duration of treatment. Standardized terminology for initiation, execution, and persistence of drug dosing is essential for clarity of communication and scientific progress. Electronic methods for compiling drug dosing histories are now the recognized standard for quantifying adherence, the parameters of which support model-based, continuous projections of drug actions and concentrations in plasma that are confirmable by intermittent, direct measurements at single time points. The frequency of inadequate adherence is usually underestimated by pre-electronic methods and thus is clinically unrecognized as a frequent cause of failed treatment or underestimated effectiveness. Intermittent lapses in dosing are potential sources of toxicity through hazardous rebound effects or recurrent first-dose effects.
患者治疗效果良好和可靠评估药物治疗模式的关键是患者能遵医嘱用药。衡量患者是否遵医嘱的标准是用药记录，包括按时开始用药和在整个规定的治疗时间内按时、持续地执行用药方案。药物剂量开始、执行和持续的标准化术语对于明确的沟通和科学进展至关重要。目前，电子方法是编制药物剂量记录的标准方法，可用于量化药物的依从性，其参数支持基于模型的药物作用和血浆浓度的连续预测，这些预测可通过单点的间歇性直接测量来证实。电子方法出现之前，不遵医嘱的频率通常被低估，因此在临床上并未被认识到是治疗失败或疗效被低估的常见原因。间歇性漏服药物可能导致有害的反弹效应或复发性首剂量效应，从而产生毒性。
