Zheng Bo, Poulose Alice, Fulford Martha, Holbrook Anne
Bachelor of Health Sciences Program, McMaster University, Canada.
J Popul Ther Clin Pharmacol. 2012;19(2):e239-47. Epub 2012 Jul 12.
Cost-related nonadherence (CRN) describes patients cutting back on their prescribed medication due to an inability to pay. CRN is influenced by drug insurance coverage plans, which vary widely among different healthcare systems. Little is known about CRN in Canada and Ontario.
To develop and pilot a questionnaire about CRN.
An interviewer-administered questionnaire assessing demographics, socioeconomic status, health status and health literacy, medication costs and CRN was developed for this pilot study. Participants were recruited from a general internal medicine rapid assessment outpatient clinic of a large urban teaching hospital.
Sixty patients were recruited (mean age 60.3 years; 48.3% female; mean of 5.3 prescription medications per patient). Nine patients (15%) reported some form of CRN. Unfilled prescriptions, delayed prescriptions, less frequent and smaller doses were the most common forms of CRN. Seven patients (11.7%) had no drug insurance. Patients without drug insurance were more likely to experience CRN than patients with private insurance (OR 20.70, 95% CI 1.46-292.75); government coverage also increased the likelihood of CRN compared to private coverage (OR 4.51, 95% CI 0.376-54.11). Patients spending over $100 a month out-of-pocket were more likely to experience CRN than patients spending less than $20 (OR 42.52, 95% CI 2.02-894.03). Thirty-three patients (55%) said that their physicians had not asked them about how they deal with the cost of prescriptions.
Based on our pilot survey, a significant minority of specialty clinic outpatients experience CRN and prescribers frequently forget to inquire whether patients can afford their medications.
费用相关的治疗不依从性（CRN）指患者因无力支付而减少所开药物的服用量。CRN受药物保险覆盖计划的影响，不同医疗体系中的此类计划差异很大。在加拿大和安大略省，人们对CRN了解甚少。
开发并试行一份关于CRN的调查问卷。
为本项试行研究设计了一份由访员实施的调查问卷，用于评估人口统计学特征、社会经济状况、健康状况和健康素养、药物费用及CRN。研究对象从一家大型城市教学医院的普通内科快速评估门诊招募。
招募了60名患者（平均年龄60.3岁；48.3%为女性；每位患者平均服用5.3种处方药）。9名患者（15%）报告有某种形式的CRN。未取药、延迟取药、减少服药频率和减小服药剂量是CRN最常见的形式。7名患者（11.7%）没有药物保险。没有药物保险的患者比有私人保险的患者更易出现CRN（比值比20.70，95%可信区间1.46 - 292.75）；与私人保险相比，政府保险也增加了CRN的可能性（比值比4.51，95%可信区间0.376 - 54.11）。每月自付费用超过100美元的患者比自付费用低于20美元的患者更易出现CRN（比值比42.52，95%可信区间2.02 - 894.03）。33名患者（55%）表示其医生未询问过他们如何应对处方药费用。
根据我们的试行调查，相当一部分专科门诊患者存在CRN，而开处方者常常忘记询问患者是否负担得起药物费用。
