Marengoni Alessandra, Onder Graziano, Degli Esposti Luca, Russo Pierluigi, Sangiorgi Diego, Buda Stefano, Fini Massimo, Marchionni Niccolò, Bonassi Stefano, Mammarella Federica, Marrocco Walter, Pozzi Giuseppe, Palmer Katie, Monaco Alessandro, Pecorelli Sergio, Pani Luca
Department of Clinical and Experimental Sciences, University of Brescia, Italy, Viale Europa 23, 25123 Brescia, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Italy.
J Clin Psychiatry. 2016 Dec;77(12):1712-1718. doi: 10.4088/JCP.15m10503.
This study aimed to evaluate prevalence of prescription of and adherence to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and whether adherence to these classes of drugs affects overall medication adherence in older persons.
In a cross-sectional analysis of administrative data comprehensive of all prescribed drugs reimbursed by the Italian national health care system, new prescriptions of SSRIs and SNRIs to persons aged 65 years or older were analyzed (n = 380,400 in 2011; 395,806 in 2012; 409,741 in 2013, from a total sample of 3,762,299 persons aged 65 years or older) as well as prescriptions of antihypertensives, statins, other psychiatric drugs, antidiabetics, antiplatelets, anticoagulants, drugs for chronic obstructive pulmonary disease, and antiosteoporotics. Adherence was estimated by calculating the proportion of days covered by drugs dispensed during a period of 365 days. Adherence was defined as a proportion of days covered of more than 80%.
Prevalence of SSRI and SNRI prescriptions varied from 11.4% in 2011 to 12.1% in 2013. Adherence to SSRI and SNRI prescriptions ranged from 31.2% in persons aged ≥ 95 years in 2011 to 41.8% in persons aged 75-84 years in 2013. Persons adherent to SSRI and SNRI prescriptions were more likely to be adherent to the other medications, after adjustment for age, gender, and number of drugs prescribed. The highest association was found for adherence to psychiatric drugs (OR = 1.9; 95% CI, 1.8-2.0).
Adherence to SSRI and SNRI prescriptions is poor in older persons. However, people adherent to these classes of antidepressants are more likely to be adherent to the other medications they are prescribed. Studies are needed to evaluate the reasons for and the potential benefits of increasing adherence to antidepressants on overall adherence.
本研究旨在评估选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）的处方率及服药依从性，以及服用这些药物的依从性是否会影响老年人的整体用药依从性。
在一项对意大利国家医疗保健系统报销的所有处方药进行综合分析的横断面研究中，分析了65岁及以上老年人的SSRIs和SNRIs新处方（2011年为380,400例；2012年为395,806例；2013年为409,741例，总样本为3,762,299例65岁及以上老年人）以及抗高血压药、他汀类药物、其他精神类药物、抗糖尿病药、抗血小板药、抗凝药、慢性阻塞性肺疾病用药和抗骨质疏松药的处方。通过计算365天内所配药物覆盖天数的比例来估算依从性。依从性定义为药物覆盖天数比例超过80%。
SSRI和SNRI处方率从2011年的11.4%至2013年的12.1%不等。SSRI和SNRI处方的依从性范围从2011年95岁及以上人群的31.2%至2013年75 - 84岁人群的41.8%。在对年龄、性别和处方药物数量进行调整后，服用SSRI和SNRI处方的患者更有可能坚持服用其他药物。在坚持服用精神类药物方面发现了最高的关联（OR = 1.9；95% CI，1.8 - 2.0）。
老年人对SSRI和SNRI处方的依从性较差。然而，服用这些抗抑郁药物的人更有可能坚持服用他们所开的其他药物。需要开展研究来评估提高抗抑郁药物依从性对整体依从性的原因及潜在益处。
