Department of Medical and Surgical Sciences - Pharmacology Unit, University of Bologna, Via Irnerio, 48, 40126, Bologna, BO, Italy.
Eur J Clin Pharmacol. 2013 Dec;69(12):2095-101. doi: 10.1007/s00228-013-1567-8. Epub 2013 Aug 1.
To describe antidepressant (AD) use in the Emilia-Romagna Region (Italy) and to evaluate adherence to treatment with selective serotonin receptor inhibitors or selective noradrenaline receptor inhibitors (SSRI-SNRI).
Reimbursed prescriptions of AD were retrieved from the Emilia-Romagna Regional Health Authority Database. The overall AD consumption from the 2006-2011 period was expressed in terms of prevalence and amount of use. Adherence to treatment was assessed in a cohort of patients who received SSRI-SNRI, and was followed throughout a 6-month period from the start of each treatment episode. Adherence was considered according to three parameters: duration of treatment ≥ 120 days, prescription coverage ≥ 80 %, and gaps between prescriptions < 3 months. Determinants of non-adherent regimen, including sociodemographic and clinical variables, were identified by multivariate logistic regression by calculating adjusted Odds Ratio (adjOR) and the relevant 95 % confidence interval (95CI).
From 2006 to 2011, the prevalence of use of AD increased by 5 % (from 86 to 90 per 1,000 inhabitants) and the amount of antidepressant consumption increased by 20 % (from 43 to 51 defined daily dose per thousand inhabitants per day [DDD/TID]), with a 14 % rise in the intensity of drug use (from 182 to 208 DDD per patient). Out of 347,615 SSRI-SNRI treatment episodes, only 23.8 % were adherent. Comorbidity (adjOR:0.69; 95CI:0.67-0.72) and recurrence of AD treatment in the previous year (0.91; 0.89-0.92) were associated with better adherence. Moreover, patients treated with duloxetine (0.58; 0.55-0.60), escitalopram (0.64; 0.62-0.66) or sertraline (0.65; 0.64-0.67) showed better adherence in comparison with paroxetine.
Clinical variables resulting in improved adherence seem to identify patients with more severe disorders and who actually need a pharmacological approach, whereas differences in adherence among ADs could in part be caused by channeling and sponsorship bias. Initiatives addressed at improving cooperation between primary care and psychiatrists could decrease AD prescription for cases of sub-threshold or mild depression that easily drop out because of rapid symptom relief or side effects.
描述意大利艾米利亚-罗马涅地区（Emilia-Romagna Region）抗抑郁药（AD）的使用情况，并评估选择性 5-羟色胺再摄取抑制剂或选择性去甲肾上腺素再摄取抑制剂（SSRI-SNRI）治疗的依从性。
从艾米利亚-罗马涅地区卫生局数据库中检索 AD 的报销处方。2006-2011 年期间的总体 AD 消费情况以患病率和使用量表示。对接受 SSRI-SNRI 治疗的患者队列进行了治疗依从性评估，并在每个治疗阶段开始后 6 个月内进行了随访。根据以下三个参数评估治疗依从性：治疗持续时间≥120 天、处方覆盖率≥80%和处方间隔<3 个月。通过多变量逻辑回归计算调整后的优势比（adjOR）及其相关 95%置信区间（95%CI），确定非依从治疗方案的决定因素，包括社会人口统计学和临床变量。
2006 年至 2011 年，AD 的使用率增加了 5%（从每 1000 名居民 86 人增加到 90 人），抗抑郁药消费增加了 20%（从每千名居民每天 43 个增加到 51 个定义日剂量[DDD/TID]），药物使用强度增加了 14%（从每患者 182 个增加到 208 个 DDD）。在 347615 例 SSRI-SNRI 治疗发作中，仅有 23.8%是依从的。合并症（adjOR：0.69；95CI：0.67-0.72）和前一年 AD 治疗复发（0.91；0.89-0.92）与更好的依从性相关。此外，与帕罗西汀相比，接受度洛西汀（0.58；0.55-0.60）、依西酞普兰（0.64；0.62-0.66）或舍曲林（0.65；0.64-0.67）治疗的患者具有更好的依从性。
导致治疗依从性提高的临床变量似乎可以识别出病情更严重且实际上需要药物治疗的患者，而 AD 之间的依从性差异部分可能是由于渠道和赞助偏见造成的。旨在改善初级保健和精神科医生之间合作的举措可以减少阈下或轻度抑郁的处方，因为这些患者的症状迅速缓解或出现副作用后很容易脱落。
