Chair on Adherence to Treatments, Université Laval, 1050 chemin Ste-Foy, Québec, QC, Canada; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, 1050 chemin Ste-Foy, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec, QC, Canada.
Centre de Recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Unité 218, 7331 Rue Hochelaga, Montréal, QC, Canada.
Res Social Adm Pharm. 2018 Jan;14(1):53-61. doi: 10.1016/j.sapharm.2016.12.006. Epub 2016 Dec 28.
Non-adherence is a major obstacle to optimal treatment of schizophrenia. Community pharmacists are in a key position to detect non-adherence and put in place interventions. Their role is likely to be more efficient when individuals are loyal to a single pharmacy.
To assess the association between the level of community pharmacy loyalty and persistence with and implementation of antipsychotic drug treatment among individuals with schizophrenia.
A cohort study using databases from the Quebec health insurance board (Canada) was conducted among new antipsychotic users insured by Quebec's public drug plan. Level of community pharmacy loyalty was assessed as the number of pharmacies visited in the year after antipsychotics initiation. Persistence was defined as having an antipsychotic supply in the user's possession on the 730 day after its initiation and implementation as having antipsychotics in the user's possession for ≥80% of the days in the second year after antipsychotics initiation (among persistent only). Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95%CI).
6,251 individuals were included in the cohort and 54.1% had their drug prescriptions filled in >1 pharmacy. When compared to those who had their prescriptions filled in a single pharmacy, those who had their prescriptions filled in ≥4 different pharmacies were 22% more likely to be non-persistent (aPR = 1.22; 95%CI = 1.10-1.37) and 49% more likely to have an antipsychotic for <80% of the days (aPR = 1.49; 95%IC = 1.28-1.74).
This first exploration of community pharmacy loyalty in the context of severe mental illness indicates that this healthcare organisation factor might be associated with antipsychotics persistence and implementation. Identification of individuals with low community pharmacy loyalty and initiatives to optimize community pharmacy loyalty could contribute to enhanced persistence and implementation.
不遵医嘱是精神分裂症最佳治疗的主要障碍。社区药剂师处于发现不遵医嘱并实施干预的关键位置。当个人忠于一家药店时，他们的作用可能更有效。
评估个体对社区药房的忠诚度水平与精神分裂症患者抗精神病药物治疗的坚持性和实施之间的关系。
在魁北克省公共药物计划承保的新使用抗精神病药物的患者中，使用魁北克省健康保险委员会（加拿大）的数据库进行了队列研究。社区药房忠诚度水平评估为抗精神病药物开始后一年内访问的药店数量。坚持治疗定义为抗精神病药物开始后第 730 天用户仍持有抗精神病药物供应，实施定义为抗精神病药物开始后第二年用户仍持有≥80%的天数的抗精神病药物（仅限于坚持治疗者）。使用广义线性模型估计调整后的患病率比（aPR）和 95%置信区间（95%CI）。
该队列纳入了 6251 名患者，其中 54.1%的患者在≥1 家药店配药。与那些在单一药店配药的患者相比，那些在≥4 家不同药店配药的患者不坚持治疗的可能性高 22%（aPR=1.22；95%CI=1.10-1.37），有抗精神病药物的天数<80%的可能性高 49%（aPR=1.49；95%CI=1.28-1.74）。
这是首次在严重精神疾病背景下探索社区药房忠诚度，表明该医疗保健组织因素可能与抗精神病药物的坚持治疗和实施有关。识别社区药房忠诚度低的个体并采取措施优化社区药房忠诚度，可能有助于提高坚持治疗和实施。
