Gurwitz J H, Glynn R J, Monane M, Everitt D E, Gilden D, Smith N, Avorn J
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Am J Public Health. 1993 May;83(5):711-6. doi: 10.2105/ajph.83.5.711.
The purpose of this study was to determine the extent of nonadherence to treatment for glaucoma among elderly patients.
This was a retrospective cohort study of 2440 patients older than age 65 who were enrolled in the New Jersey Medicaid Program and who were newly initiated on a topical agent for the treatment of glaucoma. Two patient-specific measures of nonadherence were employed: (1) no filled prescription for any glaucoma medication over a 12-month period after the initiation of therapy and (2) number of days without therapy for glaucoma during this 12-month period.
By the first measure, 569 patients (23%) were found to be nonadherent. The mean number of days without therapy during the study year was 112. Factors associated with nonadherence included the use of glaucoma medication requiring more than 2 administrations per day and the presence of multiple other medications in the patient's drug regimen. Patients started on multiple glaucoma medication were more adherent than those started on a single agent. Age and sex were not found to be predictors of nonadherence.
Substantial nonadherence was found to be common in this population. More attention to the issue of nonadherence could result in important benefits in the preservation of sight.
本研究旨在确定老年青光眼患者治疗不依从的程度。
这是一项对2440名65岁以上患者的回顾性队列研究，这些患者参加了新泽西医疗补助计划，且刚开始使用局部用药治疗青光眼。采用了两种针对患者的不依从性测量方法：（1）在开始治疗后的12个月内没有任何青光眼药物的处方配药记录，以及（2）在这12个月内没有接受青光眼治疗的天数。
根据第一种测量方法，发现569名患者（23%）存在治疗不依从情况。研究年度内未接受治疗的平均天数为112天。与不依从相关的因素包括使用每天需要给药超过2次的青光眼药物，以及患者药物治疗方案中存在多种其他药物。开始使用多种青光眼药物的患者比开始使用单一药物的患者依从性更高。未发现年龄和性别是不依从的预测因素。
在这一人群中发现大量治疗不依从情况很常见。更多地关注不依从问题可能会在保护视力方面带来重要益处。
