Stange Dorit, Kriston Levente, von-Wolff Alessa, Baehr Michael, Dartsch Dorothee C
University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
J Manag Care Pharm. 2013 Jun;19(5):396-407. doi: 10.18553/jmcp.2013.19.5.396.
Patient adherence is necessary for successful medication therapy. However, highly complex medication regimens may lead to poor adherence, which decreases the effectiveness of treatment and often results in treatment failure, excessive morbidity and mortality, and higher costs.
To examine whether patient adherence can be increased indirectly through reducing medication complexity by (a) pharmaceutical counseling of hospital medical staff and (b) additional information in the discharge letter for the primary care provider (PCP) about the simplified discharge medication.
At the Medical Center Hamburg-Eppendorf, a tertiary care university hospital in Germany, 240 chronically ill inpatients with hypertension, diabetes, and/or dyslipidemia were enrolled in this prospective, semirandomized study. For the intervention group, hospital doctors were counseled by a clinical pharmacist on feasible simplifications of cardiovascular and antidiabetic medications. In 1 randomized subgroup, the PCP received additional explanatory information in the discharge letter. Adherence (self-reporting using the Medication Adherence Rating Scale [MARS-D]) and medication complexity (using the Medication Regimen Complexity Index [MRCI-D]) were recorded at admission to the hospital, discharge from the hospital, and 6 weeks after discharge. Patient quality of life (QoL) and satisfaction with information about medications were assessed at admission and after discharge.
At discharge, the medication regimen in the intervention group was significantly less complex than in the comparison group. Yet, 6 weeks after discharge, the complexity of the outpatient medication had increased to values similar to the comparison group, unless the PCP received additional information in the discharge letter. Propensity adjusted complete adherence rates at discharge were slightly, but not significantly, higher in the intervention group than in the comparison group. Within the intervention group, complete adherence was more frequent in the subgroup with additional information for the PCP. Patient QoL and satisfaction with information were comparable in both groups.
The complexity of cardiovascular and antidiabetic hospital medications can be reduced by counseling the hospital doctors. However, for a sustainable simplification of outpatient medication, the PCPs must receive explicit information about the modifications. Patient adherence was not significantly influenced by this intervention. To verify these results, further research with objective measures of adherence and in patients with other diseases is needed.
患者的依从性是药物治疗成功的必要条件。然而，高度复杂的药物治疗方案可能导致依从性差，这会降低治疗效果，并常常导致治疗失败、发病率和死亡率过高以及成本增加。
通过以下方式减少药物治疗的复杂性，以间接提高患者的依从性：(a) 对医院医务人员进行药学咨询；(b) 在出院小结中向初级保健提供者（PCP）提供关于简化出院用药的额外信息。
在德国汉堡-埃彭多夫医学中心（一家三级医疗大学医院），240名患有高血压、糖尿病和/或血脂异常的慢性病住院患者参与了这项前瞻性半随机研究。对于干预组，临床药剂师就心血管药物和抗糖尿病药物可行的简化方案向医院医生提供咨询。在1个随机亚组中，PCP在出院小结中收到了额外的解释性信息。在入院时、出院时以及出院后6周记录依从性（使用药物治疗依从性评定量表 [MARS-D] 进行自我报告）和药物治疗复杂性（使用药物治疗方案复杂性指数 [MRCI-D]）。在入院时和出院后评估患者的生活质量（QoL）以及对药物信息的满意度。
出院时，干预组的药物治疗方案复杂性显著低于对照组。然而，出院6周后，除非PCP在出院小结中收到额外信息，门诊用药的复杂性已增加至与对照组相似的值。干预组出院时倾向调整后的完全依从率略高于对照组，但差异不显著。在干预组中，PCP收到额外信息的亚组完全依从性更常见。两组患者的QoL和对信息的满意度相当。
通过向医院医生提供咨询，可以降低心血管和抗糖尿病医院用药的复杂性。然而，为了可持续地简化门诊用药，PCP必须收到关于这些调整的明确信息。这项干预对患者依从性没有显著影响。为了验证这些结果，需要采用客观的依从性测量方法并在患有其他疾病的患者中进行进一步研究。
