Centre of Development, Primary Health Care of the Capital Area, Thönglabakki 1, 109 Reykjavik, Iceland.
Fam Pract. 2013 Feb;30(1):69-75. doi: 10.1093/fampra/cms049. Epub 2012 Sep 10.
Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known.
To determine the prevalence of primary non-adherence, test whether it is influenced by a moderate increase in patient copayment implemented in 2010 and examine the difference between copayment groups (general versus concession patients).
A population-based data linkage study, wherein prescriptions issued electronically by 140 physicians at 16 primary health care centres in the Reykjavik capital area during two periods before and after increases in copayment were matched with those dispensed in pharmacies, the difference constituting primary non-adherence (population: 200 000; patients: 21 571; prescriptions: 22 991). Eight drug classes were selected to reflect symptom relief and degree of copayment. Two-tailed chi-square test and odds ratios for non-adherence by patient copayment groups were calculated.
The rate of primary non-adherence was 6.2%. It was lower after the increased copayment, reaching statistical significance for hypertensive agents, non-steroidal anti-inflammatory drugs (NSAIDs) and antipsychotics. Generally, primary non-adherence, except for antibacterials and NSAIDs, was highest in old-age pensioners.
Primary non-adherence in Icelandic general practice was within the range of prior studies undertaken in other countries and was not adversely affected by the moderate increase in patient copayment. Older patients showed a different pattern of primary non-adherence. This may possibly be explained by higher prevalence of medicine use.
主要非依从性是指患者在药物治疗的某个时间点没有兑现规定的药物。研究主要集中在次要非依从性上。在这项研究之前，冰岛一般实践中主要非依从性的总体率尚不清楚。
确定主要非依从性的流行率，检验 2010 年实施的适度增加患者共付额是否会对此产生影响，并检查共付额组（普通患者与优惠患者）之间的差异。
一项基于人群的数据关联研究，其中雷克雅未克首都地区 16 个初级保健中心的 140 名医生通过电子方式开出的处方，在增加共付额前后的两个时期与药房配药进行匹配，两者之间的差异构成主要非依从性（人群：200 000；患者：21 571；处方：22 991）。选择了八种药物类别来反映症状缓解和共付额程度。计算了按患者共付额组划分的非依从性的双侧卡方检验和比值比。
主要非依从性的比率为 6.2%。在增加共付额后，该比率降低，降压药、非甾体抗炎药（NSAIDs）和抗精神病药达到统计学意义。一般来说，除了抗菌药和 NSAIDs 外，高龄养老金领取者的主要非依从性最高。
冰岛一般实践中的主要非依从性处于其他国家进行的先前研究的范围内，且并未受到患者共付额适度增加的不利影响。老年患者表现出不同的主要非依从性模式。这可能是由于用药的普遍性更高所导致的。
