Aznar-Lou Ignacio, Fernández Ana, Gil-Girbau Montserrat, Fajó-Pascual Marta, Moreno-Peral Patricia, Peñarrubia-María María Teresa, Serrano-Blanco Antoni, Sánchez-Niubó Albert, March-Pujol María Antonia, Jové Anna Maria, Rubio-Valera Maria
Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain.
Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.
Br J Clin Pharmacol. 2017 Jun;83(6):1328-1340. doi: 10.1111/bcp.13215. Epub 2017 Feb 24.
Adherence to medicines is vital in treating diseases. Initial medication non-adherence (IMNA) - defined as not obtaining a medication the first time it is prescribed - has been poorly explored. Previous studies show IMNA rates between 6 and 28% in primary care (PC). The aims of this study were to determine prevalence and predictive factors of IMNA in the most prescribed and expensive pharmacotherapeutic groups in the Catalan health system.
This is a retrospective, register-based cohort study which linked the Catalan PC System (Spain) prescription and invoicing databases. Medication was considered non-initiated when it was not collected from the pharmacy by the end of the month following the one in which it was prescribed. IMNA prevalence was calculated using July 2013-June 2014 prescription data. Predictive factors related to patients, general practitioners and PC centres were identified through multilevel logistic regression analyses. Missing data were attributed using simple imputation.
Some 1.6 million patients with 2.9 million prescriptions were included in the study sample. Total IMNA prevalence was 17.6% of prescriptions. The highest IMNA rate was observed in anilides (22.6%) and the lowest in angiotensin-converting-enzyme (ACE) inhibitors (7.4%). Predictors of IMNA are younger age, American nationality, having a pain-related or mental disorder and being treated by a substitute/resident general practitioner in a resident-training centre.
The rate of IMNA is high when all medications are taken into account. Attempts to strengthen trust in resident general practitioners and improve motivation to initiate a needed medication in the general young and older immigrant population should be addressed in Catalan PC.
坚持服药对疾病治疗至关重要。初始药物治疗不依从（IMNA）——定义为首次开具药物处方时未取药——尚未得到充分研究。先前的研究表明，初级保健（PC）中的IMNA发生率在6%至28%之间。本研究的目的是确定加泰罗尼亚卫生系统中最常处方和最昂贵的药物治疗组中IMNA的患病率及预测因素。
这是一项基于登记的回顾性队列研究，将加泰罗尼亚PC系统（西班牙）的处方和发票数据库相链接。如果在开具处方后的次月月底前未从药房取药，则视为未开始用药。使用2013年7月至2014年6月的处方数据计算IMNA患病率。通过多水平逻辑回归分析确定与患者、全科医生和PC中心相关的预测因素。使用简单插补法处理缺失数据。
研究样本纳入了约160万患者的290万张处方。IMNA的总患病率为处方的17.6%。在酰苯胺类药物中观察到最高的IMNA发生率（22.6%），而在血管紧张素转换酶（ACE）抑制剂中最低（7.4%）。IMNA的预测因素包括年龄较小、美国国籍、患有疼痛相关或精神障碍以及在住院医师培训中心由替代/住院医师全科医生治疗。
若将所有药物考虑在内，IMNA发生率较高。加泰罗尼亚PC应尝试加强对住院医师全科医生的信任，并提高年轻和老年移民人群开始使用所需药物的积极性。
