Watanabe Norio, Yamamura Keiko, Suzuki Yusuke, Umegaki Hiroyuki, Shigeno Katsuro, Matsushita Ryo, Sai Yoshimichi, Miyamoto Ken-Ichi, Yamada Kiyofumi
Department of Clinical Pharmacy, Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Ishikawa, Japan.
Patient Prefer Adherence. 2012;6:605-11. doi: 10.2147/PPA.S34984. Epub 2012 Aug 28.
Donepezil is widely used to delay the progression of cognitive dysfunction in patients with Alzheimer's disease (AD), but the efficacy of pharmacotherapy is often reduced by poor adherence to medication. In order to improve adherence by providing information about AD and the significance of pharmacotherapy, the Donepezil Outpatient Consultation Service (DOCS) was set up. The influence of this service on medication persistence was assessed in the present study.
Among outpatients starting donepezil therapy, we enrolled 59 patients between April 2008 and September 2010 before establishment of the DOCS (non-DOCS group) and 52 patients between October 2010 and March 2012 who attended the DOCS (DOCS group). Each patient's and their caregiver's understanding about the clinical features of AD and pharmacotherapy with donepezil were also assessed. Their understanding was compared before and after the DOCS, and the 1-year medication persistence rate and the reasons for discontinuation were also investigated.
The 1-year medication persistence rate was significantly higher in the DOCS group than in the non-DOCS group (73.1% vs 49.2%, P = 0.008). We examined the association of medication persistence with age, sex, clinical dementia rating, living alone, and attending the DOCS. As a result, medication persistence was significantly higher in patients attending the DOCS. The main reasons for discontinuation of donepezil were transfer elsewhere (11) and gastrointestinal side effects (5) in the non-DOCS group, and transfer (9) and gastrointestinal side effects (3) in the DOCS group. The overall score for understanding was 2.5 ± 1.7 before attending the DOCS and it increased significantly to 5.7 ± 0.7 afterward (P < 0.001).
The DOCS consultation provided by hospital pharmacists for AD patients and their caregivers improved understanding about the clinical features of dementia and provided pharmacological knowledge about antidementia drugs, leading to better adherence to pharmacotherapy that could maximize its effect.
多奈哌齐被广泛用于延缓阿尔茨海默病（AD）患者认知功能障碍的进展，但药物治疗的疗效常因患者服药依从性差而降低。为了通过提供有关AD及药物治疗重要性的信息来提高依从性，设立了多奈哌齐门诊咨询服务（DOCS）。本研究评估了该服务对药物持续使用情况的影响。
在开始多奈哌齐治疗的门诊患者中，我们纳入了2008年4月至2010年9月期间在DOCS设立之前开始治疗的59例患者（非DOCS组）以及2010年10月至2012年3月期间接受DOCS服务的52例患者（DOCS组）。还评估了每位患者及其照顾者对AD临床特征和多奈哌齐药物治疗的了解情况。比较了他们在接受DOCS服务前后的了解情况，并调查了1年的药物持续使用率及停药原因。
DOCS组的1年药物持续使用率显著高于非DOCS组（73.1%对49.2%，P = 0.008）。我们研究了药物持续使用情况与年龄、性别、临床痴呆评定、独居及接受DOCS服务之间的关联。结果显示，接受DOCS服务的患者药物持续使用率显著更高。非DOCS组停用多奈哌齐的主要原因是转至其他地方（11例）和胃肠道副作用（5例），DOCS组为转至其他地方（9例）和胃肠道副作用（3例）。接受DOCS服务前了解情况的总分为2.5±1.7，之后显著提高至5.7±0.7（P < 0.001）。
医院药剂师为AD患者及其照顾者提供的DOCS咨询改善了对痴呆临床特征的了解，并提供了有关抗痴呆药物的药理学知识，从而提高了药物治疗的依从性，使药物疗效最大化。
