Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health.
Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.
Med Care. 2018 Jun;56(6):510-519. doi: 10.1097/MLR.0000000000000911.
Selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety disorders but adherence remains difficult to predict.
To estimate SSRI adherence in children with anxiety disorders and determine if prior parental medication adherence is predictive of child high SSRI adherence.
We identified children (3-17 y) initiating SSRI treatment after an anxiety disorder diagnosis in a commercial claims database (2005-2014). We evaluated parent SSRI, statin, and antihypertensive adherence [6-mo proportion days covered (PDC), high adherence=PDC≥0.80] in the year before child SSRI initiation. We estimated risk differences (RD) of child high SSRI adherence (6-mo PDC) stratified by parent adherence and multivariable risk ratios using modified Poisson regression. We estimated change in c-statistic and risk reclassification when adding parent-level covariates with child-level covariates to predict child adherence.
In 70,979 children with an anxiety disorder (59%=female, 14=median age), the mean 6-month SSRI PDC was 0.72, with variation by anxiety disorder. Overall 64% of children had high adherence if their parent had high SSRI adherence versus 53% of children with parents with low SSRI adherence (RD, 12%; multivariable risk ratios, 1.17; 95% confidence interval, 1.14-1.20). Findings were similar for parent statin (RD=10%) and antihypertensive adherence (RD=8%) and when stratified by child age and parent sex. There was minor improvement in risk reclassification and the c-statistic after adding parent adherence and parent-level covariates.
Parental medication adherence could help providers identify children at risk of nonadherence to inform the treatment decision, reduce unnecessary medication switches, and lead to broader effective interventions.
选择性 5-羟色胺再摄取抑制剂（SSRIs）是治疗儿童焦虑症的首选一线药物治疗方法，但仍难以预测其依从性。
评估患有焦虑症的儿童对 SSRIs 的依从性，并确定父母先前的药物依从性是否可以预测儿童对 SSRIs 的高依从性。
我们在商业索赔数据库（2005-2014 年）中确定了患有焦虑症后开始使用 SSRIs 治疗的儿童（3-17 岁）。我们评估了儿童 SSRI 治疗前一年内父母的 SSRI、他汀类药物和抗高血压药物的依从性（6 个月的比例天数覆盖（PDC），高依从性=PDC≥0.80）。我们使用校正泊松回归估计了按父母依从性分层的儿童高 SSRI 依从性（6 个月 PDC）的风险差异（RD），并计算了多变量风险比。我们估计了当将父母水平的协变量与儿童水平的协变量一起添加到预测儿童依从性的模型中时，C 统计量和风险重新分类的变化。
在 70979 名患有焦虑症的儿童中（59%=女性，14 岁=中位年龄），SSRI 的平均 6 个月 PDC 为 0.72，焦虑症类型不同 PDC 也不同。如果父母的 SSRI 依从性高，那么 64%的儿童有高依从性，而父母的 SSRI 依从性低的儿童有 53%（RD，12%；多变量风险比，1.17；95%置信区间，1.14-1.20）。对于父母的他汀类药物（RD=10%）和抗高血压药物（RD=8%），以及按儿童年龄和父母性别分层的情况，结果类似。添加父母依从性和父母水平的协变量后，风险重新分类和 C 统计量略有改善。
父母的药物依从性可以帮助医生识别出有不依从风险的儿童，为治疗决策提供信息，减少不必要的药物转换，并为更广泛的有效干预措施提供依据。
