Cramer J A, Mattson R H, Prevey M L, Scheyer R D, Ouellette V L
Veterans Administration Medical Center, Epilepsy Center, West Haven, CT 06516.
JAMA. 1989 Jun 9;261(22):3273-7.
The evaluation of the efficacy of medication is confounded when patients do not adhere to prescribed regimens. Overdosing, underdosing, and erratic dosing intervals can diminish drug action or cause adverse effects. Using a new method with epilepsy as a model, we assessed compliance with long-term medications among newly treated and long-term patients. Medication Event Monitor Systems (Aprex Corporation, Fremont, Calif) are standard pill bottles with micro-processors in the cap to record every bottle opening as a presumptive dose. Compliance rates averaged 76% during 3428 days observed: 87% of the once daily, 81% of the twice daily, 77% of the three times a day, and 39% of the four times a day dosages were taken as prescribed. Coefficients of variation of drug serum concentrations had no significant relationship to compliance rates. Pill counts overestimated compliance increasingly as compliance with the prescribed regimen declined. Neither drug serum concentrations nor pill counts would have identified the frequency of missed doses that were revealed with continuous dose observations.
当患者不遵守规定的治疗方案时，药物疗效的评估就会受到干扰。用药过量、用药不足和不规律的给药间隔会降低药物作用或导致不良反应。我们以癫痫为模型采用一种新方法，评估了新治疗患者和长期患者对长期用药的依从性。药物事件监测系统（Aprex公司，加利福尼亚州弗里蒙特）是一种标准药瓶，瓶盖内装有微处理器，可将每次药瓶开启记录为一次假定的给药。在观察的3428天期间，依从率平均为76%：每日一次给药的依从率为87%，每日两次给药的依从率为81%，每日三次给药的依从率为77%，每日四次给药的依从率为39%。药物血清浓度的变异系数与依从率无显著关系。随着对规定治疗方案依从性的下降，药丸计数对依从性的高估程度越来越大。无论是药物血清浓度还是药丸计数，都无法确定连续剂量观察所揭示的漏服剂量频率。
