Colvin Natasha N, Mospan Cortney M, Buxton Jennifer A, Waggett John Davie, Gillette Chris
J Am Pharm Assoc (2003). 2018 Jul-Aug;58(4S):S59-S63.e2. doi: 10.1016/j.japh.2018.04.024. Epub 2018 Jun 9.
To 1) identify barriers to medication adherence and 2) examine the relationship between the Indian Health Service (IHS) 3 prime questions and medication adherence in patients with diabetes, hypertension, or hyperlipidemia before and 6 months after intervention.
This quasi-experimental study evaluated the effectiveness of an adherence program at an independent community pharmacy. Patients who met inclusion criteria were telephoned monthly to answer questions related to their medications. Patients served as their own controls to show comparison between pre- and postintervention adherence rates calculated according to proportion of days covered over the previous 6 months. Mean medication adherences before and after intervention were assessed via paired t test. Linear regression was used to analyze predictors of average medication adherence. The Charlson Comorbidity Index was used to measure the impact of comorbid conditions on medication adherence.
Fifty-six of 354 patients met inclusion criteria, consented, and completed the study. The percentage of patients achieving an adherence rate of 80% or more increased from 9% initially to 59% at study completion. Each medication class showed improvement in adherence rates: diabetes from 66.24% to 80.06% (P = 0.0153), hypertension from 72.33% to 81.34% (P = 0.0192), and hyperlipidemia from 64.45% to 74.66% (P = 0.0103). Overall, average medication adherence increased by 11% (P < 0.0001). The top patient-reported barrier to adherence was convenience/forgetfulness (46.43%).
Pharmacist-led counseling sessions with the use of the 3 prime questions showed short-term improvement in adherence rates among patients participating in a medication adherence program. Future studies should assess if improved adherence is sustained long-term following active intervention.
1）确定药物依从性的障碍；2）研究印第安卫生服务局（IHS）的3个主要问题与糖尿病、高血压或高脂血症患者在干预前及干预后6个月的药物依从性之间的关系。
这项准实验性研究评估了一个独立社区药房的依从性项目的效果。符合纳入标准的患者每月会接到电话，回答与他们药物相关的问题。患者自身作为对照，以显示根据前6个月的覆盖天数比例计算的干预前后依从率的比较。通过配对t检验评估干预前后的平均药物依从性。使用线性回归分析平均药物依从性的预测因素。使用查尔森合并症指数来衡量合并症对药物依从性的影响。
354名患者中有56名符合纳入标准、同意并完成了研究。依从率达到80%或更高的患者百分比从最初的9%增加到研究结束时的59%。每个药物类别在依从率上都有改善：糖尿病从66.24%提高到80.06%（P = 0.0153），高血压从72.33%提高到81.34%（P = 0.0192），高脂血症从64.45%提高到74.66%（P = 0.0103）。总体而言，平均药物依从性提高了11%（P < 0.0001）。患者报告的依从性最高障碍是便利性/遗忘（46.43%）。
使用3个主要问题由药剂师主导的咨询会议显示，参与药物依从性项目的患者的依从率有短期改善。未来的研究应评估在积极干预后，改善的依从性是否能长期维持。
