Hall Sylvie F, Edmonds Stephanie W, Lou Yiyue, Cram Peter, Roblin Douglas W, Saag Kenneth G, Wright Nicole C, Jones Michael P, Wolinsky Fredric D
J Am Pharm Assoc (2003). 2017 Jul-Aug;57(4):503-509. doi: 10.1016/j.japh.2017.05.003. Epub 2017 Jun 8.
As many as one-half of patients recommended for osteoporosis pharmacotherapy do not take their medications. To identify intervention targets, we examined patient characteristics associated with nonadherence to recommended pharmacotherapy and their reasons for nonadherence.
Data come from the Patient Activation after DXA Result Notification (PAADRN) study, a randomized controlled trial of 7749 patients aged 50 years or older presenting for dual-energy X-ray absorptiometry (DXA) at 3 health centers in the United States. We focused on the 790 patients who reported receiving a recommendation for new pharmacotherapy at baseline. Using Pearson chi-squared tests for categorical variables, 2-sample t tests for continuous variables, and multivariable multinomial logistic regression, we compared those who reported starting the recommended medication (adherers) with temporary nonadherers and nonadherers on demographics, health habits, DXA impression, 10-year probability of fracture using the assessment tool, and osteoporosis knowledge, and we examined their stated reasons for nonadherence.
Mean age was 66.8 years (SD = 8.9); 87.2% were women, and 84.2% were white. One-fourth of patients (24.8%) reported that they did not start their recommended pharmacotherapy. In the unadjusted analyses, the only factor significantly associated with nonadherence was osteoporosis knowledge, with those having better knowledge being less likely to take their medications (P < 0.05). The most common reasons for nonadherence were fear of adverse effects (53.3%), a dislike of taking medicine (25.3%), and the belief that the medication would not help their condition (16.7%).
One in 4 patients recommended for osteoporosis pharmacotherapy declined treatment because they feared potential adverse effects, did not like taking medicine, or believed that the medication would not help their condition. Improved patient counseling on the potential adverse effects of osteoporosis treatment and the risk-benefit ratio for these medications may increase adherence.
在被推荐接受骨质疏松症药物治疗的患者中，多达一半的患者未服用药物。为了确定干预目标，我们研究了与不坚持推荐药物治疗相关的患者特征及其不坚持治疗的原因。
数据来自双能X线吸收法（DXA）结果通知后的患者激活（PAADRN）研究，这是一项针对美国3个健康中心7749名50岁及以上接受双能X线吸收法（DXA）检查患者的随机对照试验。我们重点关注了790名在基线时报告收到新药物治疗推荐的患者。使用Pearson卡方检验分析分类变量，使用双样本t检验分析连续变量，并进行多变量多项逻辑回归分析，我们比较了那些报告开始服用推荐药物的患者（依从者）与暂时不依从者和不依从者在人口统计学、健康习惯、DXA检查结果、使用评估工具得出的10年骨折概率以及骨质疏松症知识方面的差异，并研究了他们所述的不依从原因。
平均年龄为66.8岁（标准差=8.9）；87.2%为女性，84.2%为白人。四分之一的患者（24.8%）报告他们没有开始服用推荐的药物治疗。在未调整的分析中，与不依从显著相关的唯一因素是骨质疏松症知识，知识水平较高的患者服用药物的可能性较小（P<0.05）。最常见的不依从原因是担心不良反应（53.3%）、不喜欢服药（25.3%）以及认为药物对病情没有帮助（16.7%）。
四分之一被推荐接受骨质疏松症药物治疗的患者拒绝治疗，原因是他们担心潜在的不良反应、不喜欢服药或认为药物对病情没有帮助。改善对患者关于骨质疏松症治疗潜在不良反应以及这些药物风险效益比的咨询可能会提高依从性。
