Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain.
Parc Sanitari Sant Joan de Déu, University of Barcelona, Sant Boi de Llobregat, Spain.
J Affect Disord. 2018 Jan 15;226:282-286. doi: 10.1016/j.jad.2017.09.057. Epub 2017 Oct 3.
Initial medication non-adherence (IMNA) to antidepressants, which are commonly used to treat depression in primary care (PC), is around 6-12%. Although it is well known that post-initial non-adherence to antidepressants increases the cost of depression, the impact of IMNA on cost is unknown. The aim of this study is to assess the impact of IMNA to Selective Serotonin Reuptake Inhibitors (SSRI) on medical visits and sick leave in patients with depression treated in PC in Catalonia (Spain).
This was a four-year retrospective register-based study (2011-2014). All PC patients of working age who received a new SSRI prescription and had a diagnosis of depression were included (N = 79,642). Treatment initiation, number of visits and days on sick leave were gathered from the database. We assessed the impact of IMNA on costs with ordered logistic regressions.
The 3-year incidence of IMNA was 15%. Initially non-adherent patients made a lesser number of GP visits (OR = 0.82; 95% CI = 0.79-0.84) but had more days on sick leave (OR = 1.25; 95% CI = 1.20-1.31). There were no differences in the number of specialist visits (OR = 1.04; 95% CI = 0.99-1.08).
Differences between adherent and non-adherent patients could be explained by non-observed variables. GP recognition and documentation of depression might be inaccurate. Costs of unpaid work and use of hospital services were not considered.
Although IMNA decreases the use of medical PC services, it increases the number of days on sick leave. This could also indicate worse health status. These consequences are currently overlooked when considering post-initial medication non-adherence.
在初级保健（PC）中，常用抗抑郁药治疗抑郁症，初始药物不依从（IMNA）率约为 6-12%。虽然众所周知，抗抑郁药初始治疗后不依从会增加抑郁症的成本，但 IMNA 对成本的影响尚不清楚。本研究旨在评估 PC 中治疗抑郁症的患者对选择性 5-羟色胺再摄取抑制剂（SSRIs）的 IMNA 对医疗就诊和病假的影响。
这是一项为期四年的回顾性基于登记的研究（2011-2014 年）。纳入了所有接受新的 SSRI 处方且诊断为抑郁症的有工作能力的 PC 患者（N=79642）。从数据库中收集治疗起始、就诊次数和病假天数。我们使用有序逻辑回归评估 IMNA 对成本的影响。
3 年的 IMNA 发生率为 15%。最初不依从的患者就诊次数较少（OR=0.82；95%CI=0.79-0.84），但病假天数较多（OR=1.25；95%CI=1.20-1.31）。专科就诊次数无差异（OR=1.04；95%CI=0.99-1.08）。
依从性和不依从性患者之间的差异可能是由未观察到的变量解释的。GP 对抑郁症的识别和记录可能不准确。未考虑无薪工作和使用医院服务的成本。
尽管 IMNA 减少了 PC 医疗服务的使用，但增加了病假天数。这也可能表明健康状况更差。在考虑初始治疗后药物不依从时，这些后果目前被忽视。
