Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain.
Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.
Pediatrics. 2022 Jan 1;149(1). doi: 10.1542/peds.2020-034371.
To estimate medication noninitiation prevalence in the pediatric population and identify the explanatory factors underlying this behavior.
Observational study of patients (<18 years old) receiving at least 1 new prescription (28 pharmaceutical subgroups; July 2017 to June 2018) in Catalonia, Spain. A prescription was considered new when there was no prescription for the same pharmaceutical subgroup in the previous 6 months. Noninitiation occurred when a prescription was not filled within 1 month or 6 months (sensitivity analysis). Prevalence was estimated as the proportion of total prescriptions not initiated. To identify explanatory factors, a multivariable multilevel logistic regression model was used, and adjusted odds ratios were reported.
Overall, 1 539 003 new prescriptions were issued to 715 895 children. The overall prevalence of 1-month noninitiation was 9.0% (ranging from 2.6% [oral antibiotics] to 21.5% [proton pump inhibitors]), and the prevalence of 6-month noninitiation was 8.5%. Noninitiation was higher in the youngest and oldest population groups, in children from families with a 0% copayment rate (vulnerable populations) and those with conditions from external causes. Out-of-pocket costs of drugs increased the odds of noninitiation. The odds of noninitiation were lower when the prescription was issued by a pediatrician (compared with a primary or secondary care clinician).
The prevalence of noninitiation of medical treatments in pediatrics is high and varies according to patients' ages and medical groups. Results suggest that there are inequities in access to pharmacologic treatments in this population that must be taken into account by health care planners and providers.
估计儿科人群中药物起始治疗的不依从率，并确定导致这种行为的相关因素。
本观察性研究纳入了 2017 年 7 月至 2018 年 6 月期间在西班牙加泰罗尼亚地区接受至少 1 种新处方（28 个药物亚组）的患者（<18 岁）。当患者在过去 6 个月内没有相同药物亚组的处方时，该处方被认为是新处方。如果患者在 1 个月或 6 个月内没有开具处方，则认为发生了起始治疗不依从（敏感性分析）。总体上，不依从率被定义为未开具的总处方比例。为了确定相关的解释因素，采用多变量多层次逻辑回归模型，报告调整后的比值比。
共开具了 1539003 张新处方给 715895 名儿童。1 个月不依从率总体为 9.0%（范围为 2.6%[口服抗生素]至 21.5%[质子泵抑制剂]），6 个月不依从率为 8.5%。在年龄最小和最大的人群中，在自付费用为 0%的家庭（弱势群体）的儿童中，以及因外部原因导致疾病的儿童中，不依从率更高。药物自付费用越高，不依从的可能性越大。与初级或二级保健临床医生相比，由儿科医生开具处方时，不依从的可能性较低。
儿科药物起始治疗不依从的比例较高，且因患者年龄和医疗组而异。结果表明，该人群在获得药物治疗方面存在不公平现象，医疗保健规划者和提供者必须考虑这一点。
