Mabotuwana Thusitha, Warren Jim, Orr Martin, Kenealy Timothy, Harrison Jeff
School of Population Health, The University of Auckland, Auckland, New Zealand.
Inform Prim Care. 2011;19(1):7-15. doi: 10.14236/jhi.v19i1.788.
Adherence to antidepressant therapy remains a major issue worldwide. Most people with depression are treated in a general practice setting, but many stop taking antidepressants before completing a six-month course as recommended by guidelines.
To determine antidepressant adherence rates as indicated in primary care prescribing data and pharmacy dispensing data; to demonstrate commonly occurring patterns related to non-adherence, using a prescription visualisation tool we have developed; and to determine whether prescribing data is a good predictor of dispensing based adherence.
We analysed general practice electronic prescribing data for the year ending 31 December 2006 and linked pharmacy dispensing records by National Health Index. We calculated medication adherence for patients starting antidepressants using a six-month evaluation period and a gap-based adherence measure. Patients with a gap of more than 15 days in antidepressant therapy were considered non-adherent. Using a prescription visualisation tool, we described common modes of non-adherence.
Out of 2713 patients, 153 satisfied our inclusion criteria. Thirty-nine percent of patients showed poor adherence based on prescribing and 68% showed poor adherence on dispensing. Prescribing based non-adherence had a positive predictive value of 98% (95% CI 92%-99%) and negative predictive value of 51% (CI 47%-52%) for dispensing based non-adherence. Three broad categories of non-adherence were identified: 1) failure to return for re-prescription, 2) failure to maintain adherence despite initial attempts and 3) failure to return for re-prescription in a timely manner.
Prescribing data identifies substantial adherence issues in antidepressant therapy. Clinicians should consider adherence issues as part of the overall treatment regime and discuss such issues during consultations.
在全球范围内，坚持抗抑郁治疗仍然是一个主要问题。大多数抑郁症患者在普通医疗环境中接受治疗，但许多人在未按照指南建议完成六个月疗程之前就停止服用抗抑郁药。
根据初级保健处方数据和药房配药数据确定抗抑郁药的依从率；使用我们开发的处方可视化工具展示与不依从相关的常见模式；并确定处方数据是否是基于配药的依从性的良好预测指标。
我们分析了截至2006年12月31日的年度普通医疗电子处方数据，并通过国民健康指数链接药房配药记录。我们使用六个月的评估期和基于间隔的依从性测量方法，计算开始服用抗抑郁药患者的药物依从性。抗抑郁治疗间隔超过15天的患者被视为不依从。使用处方可视化工具，我们描述了不依从的常见模式。
在2713名患者中，153名符合我们的纳入标准。基于处方，39%的患者显示出依从性差，基于配药则为68%。基于处方的不依从对基于配药的不依从的阳性预测值为98%（95%CI 92%-99%），阴性预测值为51%（CI 47%-52%）。确定了三类主要的不依从情况：1）未返回重新开处方；2）尽管最初尝试但仍未保持依从性；3）未及时返回重新开处方。
处方数据揭示了抗抑郁治疗中存在的严重依从性问题。临床医生应将依从性问题视为整体治疗方案的一部分，并在会诊期间讨论此类问题。
