Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis).
Psychiatr Serv. 2019 Oct 1;70(10):874-880. doi: 10.1176/appi.ps.201800515. Epub 2019 Jun 27.
The objective of this study was to evaluate rates and correlates of stimulant medication adherence in a sample of pediatric patients using data derived from electronic medical records (EMRs) from a large health care organization in a large metropolitan area. The study relied on a novel definition of medication adherence as a timely renewal of an index prescription determined using the electronically recorded issuance of a stimulant prescription in the EMR ("refill").
Prescription and sociodemographic data were extracted from the Partners HealthCare Research Patient Data Registry to calculate adherence to stimulant medication treatment.
In the EMR, 2,206 patients with prescriptions for central nervous system stimulant medication were identified. Results showed that 46% of the index prescriptions were refilled within the timeframe necessary for the patient to be considered consistently medicated. A multivariable logistic regression model predicting medication adherence from patient demographic and treatment characteristics yielded an area-under-the-curve statistic of 0.57, indicating that these characteristics predicted adherence only modestly better than chance.
EMR data from a large health care organization showed that 46% of pediatric patients were adherent to treatment with stimulants. Rates of medication adherence were worse among patients receiving care from a primary care provider than among those receiving care from a psychiatrist, in older patients, and in female patients and did not appear to be influenced by racial-ethnic group, economic class, stimulant type, or medication formulation (short or long acting). These findings, which show low rates of medication adherence among children and adolescents with ADHD, suggest the need for efforts to improve these rates.
本研究旨在通过大型大都市地区大型医疗保健组织的电子病历（EMR）数据评估接受兴奋剂药物治疗的儿科患者的用药依从率及其相关因素。本研究依赖于一种新颖的药物依从性定义，即通过在 EMR 中电子记录开具兴奋剂处方的方式来确定索引处方的及时续方（“续方”）。
从 Partners HealthCare Research 患者数据登记处提取处方和社会人口统计学数据，以计算对兴奋剂药物治疗的依从性。
在 EMR 中，确定了 2206 名有中枢神经系统兴奋剂药物处方的患者。结果表明，索引处方中有 46%在患者需要持续用药的时间内进行了续方。从患者人口统计学和治疗特征预测药物依从性的多变量逻辑回归模型产生了 0.57 的曲线下面积统计数据，表明这些特征对依从性的预测仅略优于随机预测。
来自大型医疗保健组织的 EMR 数据显示，46%的儿科患者对兴奋剂治疗具有依从性。与接受精神科医生治疗的患者相比，接受初级保健提供者治疗的患者、年龄较大的患者、女性患者以及似乎不受种族-民族群体、经济阶层、兴奋剂类型或药物剂型（短效或长效）影响的患者的药物依从率更差。这些发现表明 ADHD 儿童和青少年的药物依从率较低，这表明需要努力提高这些比率。
