Lau H S, Beuning K S, Postma-Lim E, Klein-Beernink L, de Boer A, Porsius A J
Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Pharmacy, Utrecht University, The Netherlands.
Pharm World Sci. 1996 Apr;18(2):63-8. doi: 10.1007/BF00579707.
Studies on risk factors for drug non-compliance have not taken into account the possibility of correlated outcomes. We therefore conducted a study into risk factors for non-compliance by using analysis techniques that adjust for these correlations (longitudinal data analysis). Data were obtained from interviews and pharmacy records in a cross-sectional survey in Amsterdam. The subjects were 157 elderly people aged 70 years or older. Of these subjects, 37 were residents of a home for the elderly, 40 were community-dwelling elderly who needed to be visited regularly by a district nurse, and 80 were community-dwelling elderly who did not need to be visited by a district nurse. Most drugs (78%) were used according to the directions; the remainder (22%) were not used as intended. Odds ratios (95% confidence intervals) for non-compliance for moderate and poor/wrong knowledge of the purpose of a drug as compared with good/correct knowledge were 2.8 (1.2-6.7) and 4.2 (1.5-12), respectively. Drug regimens of two times daily and more than two times daily were associated with odds ratios for non-compliance of 4.5 (1.6-12) and 4.2 (1.7-11), respectively, compared to a regimen of once daily. Compliance increased if a drug was prescribed by a specialist instead of a general practitioner odds ratio 0.1 (0.04-0.4)]. There was no significant relation between compliance and the number of drugs prescribed to a patient, sex, age, living situation, patient group, or perceived effect. This study, which was based on longitudinal data analysis, demonstrates that in elderly people non-compliance with drug therapy is related to the knowledge of purpose of a drug, the complexity of a drug regimen, and the type of prescriber. The positive association between compliance and the number of drugs prescribed found in former studies was not confirmed.
关于药物治疗不依从性风险因素的研究尚未考虑相关结果的可能性。因此，我们使用能够对这些相关性进行校正的分析技术（纵向数据分析），对不依从性的风险因素展开了一项研究。数据来源于阿姆斯特丹一项横断面调查中的访谈和药房记录。研究对象为157名70岁及以上的老年人。其中，37名是养老院居民，40名是需要社区护士定期上门访视的社区居家老年人，80名是无需社区护士上门访视的社区居家老年人。大多数药物（78%）按医嘱使用；其余（22%）未按预期使用。与对药物用途了解良好/正确相比，对药物用途了解中等及较差/错误时不依从性的比值比（95%置信区间）分别为2.8（1.2 - 6.7）和4.2（1.5 - 12）。与每日一次的用药方案相比，每日两次及每日两次以上的用药方案的不依从性比值比分别为4.5（1.6 - 12）和4.2（1.7 - 11）。如果药物由专科医生而非全科医生开具，依从性会提高（比值比0.1（0.04 - 0.4））。依从性与给患者开具的药物数量、性别、年龄、生活状况、患者群体或感知疗效之间无显著关联。这项基于纵向数据分析的研究表明，在老年人中，药物治疗不依从性与对药物用途的了解、用药方案的复杂性以及开药者类型有关。先前研究中发现的依从性与开具药物数量之间的正相关关系未得到证实。
