Gillespie David, Farewell Daniel, Brookes-Howell Lucy, Butler Christopher C, Coenen Samuel, Francis Nick A, Little Paul, Stuart Beth, Verheij Theo, Hood Kerenza
Centre for Trials Research, College of Biomedical & Life Sciences.
Division of Population Medicine, School of Medicine, Cardiff University, Cardiff.
Patient Prefer Adherence. 2017 Mar 15;11:561-569. doi: 10.2147/PPA.S119256. eCollection 2017.
To investigate the determinants of adherence to amoxicillin in patients with acute lower respiratory tract infection.
Three European data sets were used. Adherence data were collected using self-reported diaries. Candidate determinants included factors relating to patient, condition, therapy, health care system/provider, and the study in which the patient participated. Logistic and Cox regression models were used to investigate the determinants of initiation, implementation, and discontinuation of amoxicillin.
Although initiation differed across samples, implementation and discontinuation were similar. Determinants of initiation were days waited before consulting, duration of prescription, and being in a country where a doctor-issued sick certificate is required for being off work for <7 days. Implementation was higher for older participants or those with abnormal auscultation. Implementation was lower for those prescribed longer courses of amoxicillin (≥8 days). Time from initiation to discontinuation was longer for longer prescriptions and shorter for those from countries where single-handed practices were widespread.
Nonadherence to amoxicillin was largely driven by noninitiation. Differing sets of determinants were found for initiation, implementation, and discontinuation. There is a need to further understand the reasons for these determinants, the impact of poor adherence to antibiotics on outcomes, and to develop interventions to improve antibiotic use when prescribed.
探讨急性下呼吸道感染患者阿莫西林治疗依从性的决定因素。
使用了三个欧洲数据集。通过自我报告日记收集依从性数据。候选决定因素包括与患者、病情、治疗、医疗保健系统/提供者以及患者参与的研究相关的因素。采用逻辑回归和Cox回归模型研究阿莫西林起始、用药过程及停药的决定因素。
尽管各样本的起始情况不同，但用药过程和停药情况相似。起始的决定因素为就诊前等待天数、处方时长以及所在国家规定请假<7天需医生开具病假证明。年龄较大的参与者或听诊异常者的用药过程依从性较高。阿莫西林疗程较长（≥8天）者的用药过程依从性较低。处方时间越长，从起始到停药的时间越长；在单人执业普遍的国家，停药时间较短。
阿莫西林治疗的不依从主要由未起始用药导致。起始、用药过程及停药的决定因素各不相同。有必要进一步了解这些决定因素的原因、抗生素依从性差对治疗结果的影响，并制定干预措施以改善抗生素处方时的使用情况。
