Spagnoli A, Ostino G, Borga A D, D'Ambrosio R, Maggiorotti P, Todisco E, Prattichizzo W, Pia L, Comelli M
Mario Negri Research Institute, Milano, Italy.
J Am Geriatr Soc. 1989 Jul;37(7):619-24. doi: 10.1111/j.1532-5415.1989.tb01252.x.
A random sample of 46 general practitioners of the Unitá Sanitaria Locale in Torino recruited 802 elderly outpatients and collected information about complaints and current drug treatment. Within a week each patient received a home interview and details were collected on drug compliance and use of drugs other than those reported by the general practitioners. On average, each patient was taking 3.6 drugs, of which 2.9 were correctly reported by the general practitioners and 0.7 were unreported. Among the most prescribed therapeutic groups there were drugs with a narrow therapeutic index (cardiovascular drugs, diuretics, psychotropic agents) and substances whose efficacy has never been fully documented ("cerebroactive-vasoactive" agents). Age and number of complaints were positively and significantly correlated with number of prescribed drugs. Nearly half of the sample (44.4%)--more frequently women and people with higher education--were taking one or more drugs not detected by the general practitioners, often benzodiazepines taken over a long period for anxiety or insomnia. Full compliance occurred for 81.5% of the prescriptions and 59.9% of patients were correctly taking all prescribed drugs. Compliance was lower for prescriptions of the general practitioners compared with other doctors' prescriptions (eg, hospital doctor, private doctor) and probability of taking correctly all the prescribed drugs decreased with the number of medicines concurrently taken. The most common reason for noncompliance was fear of side effects.
从都灵地方卫生单位的46名全科医生中随机抽取样本，招募了802名老年门诊患者，并收集了有关主诉和当前药物治疗的信息。在一周内，对每位患者进行了家访，收集了有关药物依从性以及全科医生报告之外的其他药物使用情况的详细信息。平均而言，每位患者服用3.6种药物，其中全科医生正确报告的有2.9种，未报告的有0.7种。在最常开具的治疗类别中，有治疗指数窄的药物（心血管药物、利尿剂、精神药物）以及疗效从未得到充分证实的物质（“脑活性血管活性”药物）。年龄和主诉数量与开具的药物数量呈正相关且具有显著相关性。近一半的样本（44.4%）——女性和受过高等教育的人更为常见——正在服用一种或多种未被全科医生检测到的药物，通常是长期用于治疗焦虑或失眠的苯二氮䓬类药物。81.5%的处方完全依从，59.9%的患者正确服用了所有开具的药物。与其他医生（如医院医生、私人医生）的处方相比，全科医生开具的处方依从性较低，同时服用的药物数量越多，正确服用所有开具药物的可能性越低。不依从的最常见原因是害怕副作用。
