Research Institute Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
CIBERESP, Madrid; Community Health Service, Public Health Agency of Barcelona, Barcelona, Spain.
Br J Gen Pract. 2017 Sep;67(662):e614-e622. doi: 10.3399/bjgp17X692129. Epub 2017 Jul 31.
Initial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave.
To estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups.
A 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012.
Thirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre.
Initially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term.
Initial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.
初级保健中初始药物不依从的现象非常普遍，但以前的研究尚未评估其对医疗服务的使用和/或病假天数的影响。
评估初始药物不依从对医疗服务的使用、病假天数以及总体和特定药物组的成本的影响。
这是一项基于注册的 3 年纵向研究，纳入了 2012 年在加泰罗尼亚（西班牙）接受新药物治疗的所有初级保健患者（一个 170 万患者的队列）。
考虑了 13 个最常开处方和/或最昂贵的药物亚组。分析了所有药物和药物亚组（慢性药物、镇痛药和青霉素）。考虑了医疗服务的使用次数和病假天数。采用多水平多元线性回归。包括三个层次：患者、全科医生和初级保健中心。
初始依从的患者比不依从和部分依从的患者使用更多的药物和一些医疗服务。他们的生产力损失较低，产生了净经济回报，特别是当考虑到急性疾病药物（如青霉素）时。初始药物不依从在短期内对系统造成了更高的经济负担。
初始药物不依从似乎对生产力损失和成本有短期影响。需要评估初始药物不依从的临床后果和长期经济后果。在初级保健中促进初始药物依从性的干预措施可能会降低成本并改善健康结果。
