van der Zwaard Babette C, van Hout Wesley, Hugtenburg Jacqueline G, van der Horst Henriëtte E, Elders Petra J M
Department of General Practice and Elderly Care Medicine,VU University Medical Center, Amsterdam, The Netherlands.
Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands.
Fam Pract. 2017 Sep 1;34(5):525-531. doi: 10.1093/fampra/cmw120.
Studies based on pharmacy medication records have shown suboptimal adherence and persistence of osteoporosis treatment with oral bone sparing drugs (OBSD). Little is known about adherence and persistence of OBSD treatment in primary care. We assessed adherence and persistence of OBSD use of patients in general practices and identified associated factors.
Using electronic medical records, adherence and persistence of newly prescribed treatment with OBSD in patients from 16 general practices was retrospectively assessed. The Medication Possession Ratio (MPR) was calculated as a proxy for adherence (MPR > 75%), persistence rates were estimated using survival analysis. Determinants of adherence and persistence using logistic regression and Cox regression analysis were assessed.
OBSD treatment was initiated in 957 patients. Seventy-five percent and 45% of the patients persisted OBSD treatment for one and five years, respectively. Being adherent in the first year decreased the risk of long-term non-persistence [hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.3-0.57; P < 0.001]. Patients receiving the majority of their prescriptions by a specialist tended to be more non-persistent (HR 1.37; 96%; CI 0.96-1.94; P = 0.08). Adherence was 62.5% in the first year and 60.8% in the overall treatment period. Non-adherence was associated with the specialist being the main prescriber [odds ratio (OR) 3.76; 95% CI 2.43-5.82; P < 0.001] and younger age (<65 years, OR 1.44; 95% CI 1.01-2.08; P = 0.04).
Older age of the patients and the GP prescribing the majority of medication were associated with better adherence and persistence. Good adherence in the first prescription year was associated with better persistence.
基于药房用药记录的研究表明，口服保骨药物（OBSD）治疗骨质疏松症的依从性和持续性欠佳。对于基层医疗中OBSD治疗的依从性和持续性了解甚少。我们评估了全科医疗中患者使用OBSD的依从性和持续性，并确定了相关因素。
利用电子病历，回顾性评估了来自16家全科医疗的患者新开具的OBSD治疗的依从性和持续性。计算药物持有率（MPR）作为依从性的指标（MPR>75%），使用生存分析估计持续性率。使用逻辑回归和Cox回归分析评估依从性和持续性的决定因素。
957例患者开始接受OBSD治疗。分别有75%和45%的患者持续接受OBSD治疗1年和5年。第一年的依从性降低了长期不持续治疗的风险[风险比（HR）0.41；95%置信区间（CI）0.3 - 0.57；P<0.001]。大部分处方由专科医生开具的患者往往持续性较差（HR 1.37；96%；CI 0.96 - 1.94；P = 0.08）。第一年的依从性为62.5%，整个治疗期间为60.8%。不依从与专科医生为主要开方者相关[优势比（OR）3.76；95%CI 2.43 - 5.82；P<0.001]以及年龄较小（<65岁，OR 1.44；95%CI 1.01 - 2.08；P = 0.04）。
患者年龄较大以及全科医生开具大部分药物与更好的依从性和持续性相关。首个处方年的良好依从性与更好的持续性相关。
