Laboratory for Quality Assessment of Geriatric Therapies and Services, Drug Information Service for the Elderly, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156, Milan, Italy,
Drugs Aging. 2014 Apr;31(4):283-9. doi: 10.1007/s40266-014-0163-7.
Poor adherence may have a major impact on clinical outcome, contributing to substantial worsening of disease, increased health care costs and even death. With increasing numbers of medications, low adherence is a growing concern, seriously undermining the benefits of current medical care. Little is known about medication adherence among older adults living at home and requiring complex medication regimens.
The aim of this study was to describe adherence to drug prescriptions in a cohort of elderly patients receiving polypharmacy, discharged from an internal medicine ward.
A sample of elderly patients (65 years of age or older) discharged from an internal medicine ward in Italy throughout 2012 were enrolled. They were followed for 3 months after discharge with a structured telephone interview to collect information on drug regimens and medication adherence 15-30 days (first follow-up) and 3 months (second follow-up) after discharge. Demographic variables including age, sex, marital status and caregiver were collected.
Among 100 patients recruited, information on medication adherence was available for, respectively, 89 and 79 patients at the first and second follow-ups. Non-adherence was reported for 49 patients (55.1 %) at the first follow-up and for 55 (69.6 %) 3 months from discharge. Voluntary withdrawal of a drug and change of dosage without medical consultation were the main reasons for non-adherence at both follow-ups. The number of drugs prescribed at discharge was related to medication non-adherence at both follow-up interviews. No association was found between age and non-adherence. Only 25 patients (28.1 %) at the first follow-up and 20 (25.3 %) at the second understood the reasons for their medications.
Low medication adherence is a real, complex problem for older patients receiving polypharmacy. We found that the increasing number of drugs prescribed at hospital discharge is correlated to non-adherence and a high percentage of patients did not understand the purpose of their medications. Simplification of drug regimens and reduction of pill burdens as well as better explanations of the reason for the medications should be targets for intervention.
依从性差可能对临床结局产生重大影响，导致疾病显著恶化、医疗保健费用增加，甚至死亡。随着药物数量的增加，低依从性是一个日益严重的问题，严重影响了当前医疗保健的效果。对于居住在家中且需要复杂药物治疗方案的老年患者，其药物依从性知之甚少。
本研究旨在描述接受多种药物治疗的老年患者出院后的药物依从性。
本研究纳入了 2012 年在意大利某内科病房出院的老年患者（年龄≥65 岁）。在出院后 3 个月内，通过结构化电话访谈收集药物治疗方案和药物依从性的信息，分别在出院后 15-30 天（第一次随访）和 3 个月（第二次随访）进行。收集的人口统计学变量包括年龄、性别、婚姻状况和照顾者。
在纳入的 100 例患者中，分别有 89 例和 79 例患者在第一次和第二次随访中提供了药物依从性信息。第一次随访时，49 例（55.1%）患者报告存在不依从，出院后 3 个月时，55 例（69.6%）患者报告存在不依从。两次随访时，不依从的主要原因都是自愿停药和未经医生咨询就改变剂量。出院时开具的药物数量与两次随访时的药物不依从均相关。年龄与不依从之间无相关性。仅 25 例（28.1%）患者在第一次随访时和 20 例（25.3%）患者在第二次随访时理解其用药原因。
接受多种药物治疗的老年患者药物依从性低是一个真实而复杂的问题。我们发现，出院时开具的药物数量增加与不依从相关，且很大比例的患者不了解其用药的目的。简化药物治疗方案和减少用药负担以及更好地解释用药原因应成为干预的目标。
