加拿大温哥华无家可归成年人对抗精神病药物的依从性：一项15年回顾性队列研究。
Adherence to antipsychotic medication among homeless adults in Vancouver, Canada: a 15-year retrospective cohort study.
作者信息
Rezansoff Stefanie N, Moniruzzaman A, Fazel S, Procyshyn R, Somers J M
机构信息
Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 0X3 7JX, UK.
出版信息
Soc Psychiatry Psychiatr Epidemiol. 2016 Dec;51(12):1623-1632. doi: 10.1007/s00127-016-1259-7. Epub 2016 Jun 23.
PURPOSE
The purpose of this study was to investigate the level of adherence to antipsychotic prescription medication in a well-defined homeless cohort over a 15-year period. We hypothesized that adherence would be well below the recommended threshold for clinical effectiveness (80 %), and that it would be strongly associated with modifiable risk factors in the social environment in which homeless people live.
METHOD
Linked baseline data (including comprehensive population-level administrative prescription records) were examined in a subpopulation of participants from two pragmatic-randomized trials that investigated Housing First for homeless and mentally ill adults. Adherence to antipsychotic medication was operationalized using the medication possession ratio. Multivariable logistic regression was used to estimate effect sizes between socio-demographic, homelessness-related and illness factors, and medication possession ratio.
RESULTS
Among the 290 participants who met inclusion criteria for the current analysis, adherence to antipsychotic prescription was significantly associated with: history of psychiatric hospitalization; receipt of primary medical services; long-acting injectable antipsychotic formulations; and duration of homelessness. Mean medication possession ratio in the pre-randomization period was 0.41. Socio-demographic characteristics previously correlated with antipsychotic non-adherence were not significantly related to medication possession ratio.
CONCLUSIONS
This is the first study to quantify the very low level of adherence to antipsychotic medication among homeless people over an extended observation period of 15 years. Each of the four factors found to be significantly associated with adherence presents opportunities for intervention. Strategies to end homelessness for this population may represent the greatest opportunity to improve adherence to antipsychotic medication.
目的
本研究旨在调查一个明确界定的无家可归者队列在15年期间对抗精神病处方药的依从性水平。我们假设依从性将远低于临床有效性推荐阈值（80%），并且它将与无家可归者生活的社会环境中可改变的风险因素密切相关。
方法
在两项针对无家可归的成年精神病患者的“先住房后治疗”实用随机试验的参与者亚组中，检查了相关基线数据（包括综合的人群层面行政处方记录）。使用药物持有率来衡量对抗精神病药物的依从性。采用多变量逻辑回归来估计社会人口统计学、与无家可归相关因素和疾病因素与药物持有率之间的效应大小。
结果
在符合当前分析纳入标准的290名参与者中，对抗精神病处方的依从性与以下因素显著相关：精神病住院史；接受初级医疗服务；长效注射用抗精神病制剂；以及无家可归的持续时间。随机分组前时期的平均药物持有率为0.41。先前与抗精神病药物不依从相关的社会人口统计学特征与药物持有率无显著相关性。
结论
这是第一项在长达15年的观察期内量化无家可归者对抗精神病药物极低依从性水平的研究。发现与依从性显著相关的四个因素中的每一个都提供了干预机会。为这一人群终结无家可归状态的策略可能是改善对抗精神病药物依从性的最大机会。
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