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[患者对抗抑郁药物治疗的依从性及与不依从相关的因素]

[Adherence to patients antidepressant treatment and the factors associated of non-compiance].

作者信息

Párraga Martínez Ignacio, López-Torres Hidalgo Jesús, del Campo del Campo José M, Villena Ferrer Alejandro, Morena Rayo Susana, Escobar Rabadán Francisco

机构信息

Centro de Salud de La Roda, Servicio de Salud de Castilla-La Mancha, La Roda, Albacete, España.

Centro de Salud Zona IV de Albacete, Servicio de Salud de Castilla-La Mancha, Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Albacete, España.

出版信息

Aten Primaria. 2014 Aug-Sep;46(7):357-66. doi: 10.1016/j.aprim.2013.11.003. Epub 2014 Apr 3.

Abstract

OBJECTIVE

To know the adherence to treatment in patients who initiate antidepressant drugs and to analyze the determinant factors of non-compliance, so much clinical as sociodemographic.

DESIGN

Prospective longitudinal observational study.

LOCATION

Primary Health Care and Mental Health Surgeries of three Castilla-La Mancha Areas.

PARTICIPANTS

185 adults patients who were started in antidepressant treatment were evaluated.

MEASUREMENTS

Treatment adherence (test Haynes-Sackett, test Morisky-Green, count of tablets and MEMS), adverse effects, intensity of depressive symptoms, sociodemographic characteristics and other characteristics related to antidepressants or participants.

RESULTS

After 6months of beginning antidepressing treatment, 46.9% (95%IC: 36.5-57.3) showed an inadequate fulfilment by pill count method and 28.6% (95%IC: 19.1-38.0) with Morisky-Green's questionnaire. To 15 days the lack of adherence was 48.5% (95%IC: 40.6-56.4) and of 33.5% (95%IC: 26.1-41.0). The 38.4% (95%IC: 31.1-45.7) demonstrated some side effect during the follow-up. Using proportional risk model of Cox the variables related to compliance were: younger age, level of instruction lower than secondary studies, free medicines for pensioner, no psychotherapeutic treatment, consume a fewer antidepressants drugs and a frequency ≤ 3 visits to the family doctor 3 months previous to the study.

CONCLUSIONS

The non-compliance of antidepressant treatment in primary care is high from the first weeks after initiating it. The conditioning factors are related to sociodemographic characteristics and other patient characteristics as type of financing of pharmaceutical benefit and frequentness at primary care.

摘要

目的

了解开始使用抗抑郁药物患者的治疗依从性,并分析不依从的决定因素,包括临床因素和社会人口学因素。

设计

前瞻性纵向观察研究。

地点

卡斯蒂利亚-拉曼恰三个地区的初级卫生保健和精神卫生诊所。

参与者

对185名开始接受抗抑郁治疗的成年患者进行了评估。

测量指标

治疗依从性(海恩斯-萨克特测试、莫利斯基-格林测试、药片计数和MEMS)、不良反应、抑郁症状强度、社会人口学特征以及与抗抑郁药物或参与者相关的其他特征。

结果

开始抗抑郁治疗6个月后,通过药片计数法显示46.9%(95%置信区间:36.5-57.3)的患者依从性不足,使用莫利斯基-格林问卷评估为28.6%(95%置信区间:19.1-38.0)。在15天时,依从性缺乏率为48.5%(95%置信区间:40.6-56.4),33.5%(95%置信区间:26.1-41.0)。38.4%(95%置信区间:31.1-45.7)的患者在随访期间出现了一些副作用。使用Cox比例风险模型,与依从性相关的变量有:年龄较小、教育水平低于中学、领取养老金者免费药物、未接受心理治疗、服用抗抑郁药物较少以及在研究前3个月内到家庭医生处就诊频率≤3次。

结论

在初级保健中,抗抑郁治疗从开始后的第一周起不依从率就很高。影响因素与社会人口学特征以及其他患者特征有关,如药物福利的资助类型和在初级保健机构的就诊频率。

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