Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE)
Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE)
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DOI：
10.1007/s11606-013-2402-8
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发表时间：
2013-09-01
影响因子：
5.7
通讯作者：
Karter, Andrew J.
中科院分区：
文献类型：
--
作者：
Bauer, Amy M.;Schillinger, Dean;Karter, Andrew J.
先前的研究报道了健康素养限制与慢性病较差的疾病控制有关，但没有评估与药物依从性的潜在关联。确定健康素养限制是否与较差的抗抑郁药物依从性有关。观察性新处方队列随访研究。2006年完成一项调查并在2006-2010年间接受新的抗抑郁药物处方的成人2型糖尿病患者（N = 1366）。经验证的三项自我报告量表测量健康素养。基于验证方法的药房调剂数据的依从性离散指标：原发性不依从性（从未调剂药物）；早期非持久性（一次分配，从不重新填充）；180天和365天不持续；新处方用药间隔（NPMG；患者在处方日期后12个月内未服药的时间比例）。72%的患者被归类为有健康素养限制。在调整了社会人口统计学和临床协变量后，有健康素养限制的患者的依从性明显低于无健康素养限制的患者，无论是早期不坚持（46%对38%，p < 0.05）、180天不坚持（55%对46%，p < 0.05）还是NPMG（41%对36%，p < 0.01）。在365天时，初始依从性和非持久性没有显著关联。糖尿病成人患者抗抑郁药物依从性较差和健康素养限制可能危及抑郁症药物治疗的继续和维持阶段。研究结果强调了国家努力提高卫生素养、简化有关治疗方案的卫生沟通、提高公众对抑郁症治疗的理解以及监测抗抑郁药物依从性的重要性。(C)普通内科学会2013
Previous studies have reported that health literacy limitations are associated with poorer disease control for chronic conditions, but have not evaluated potential associations with medication adherence.To determine whether health literacy limitations are associated with poorer antidepressant medication adherence.Observational new prescription cohort follow-up study.Adults with type 2 diabetes who completed a survey in 2006 and received a new antidepressant prescription during 2006-2010 (N = 1,366) at Kaiser Permanente Northern California.Validated three-item self-report scale measured health literacy. Discrete indices of adherence based on pharmacy dispensing data according to validated methods: primary non-adherence (medication never dispensed); early non-persistence (dispensed once, never refilled); non-persistence at 180 and 365 days; and new prescription medication gap (NPMG; proportion of time that the person is without medication during 12 months after the prescription date).Seventy-two percent of patients were classified as having health literacy limitations. After adjusting for sociodemographic and clinical covariates, patients with health literacy limitations had significantly poorer adherence compared to patients with no limitations, whether measured as early non-persistence (46 % versus 38 %, p < 0.05), non-persistence at 180 days (55 % versus 46 %, p < 0.05), or NPMG (41 % versus 36%, p < 0.01). There were no significant associations with primary adherence or non-persistence at 365 days.Poorer antidepressant adherence among adults with diabetes and health literacy limitations may jeopardize the continuation and maintenance phases of depression pharmacotherapy. Findings underscore the importance of national efforts to address health literacy, simplify health communications regarding treatment options, improve public understanding of depression treatment, and monitor antidepressant adherence. (C) Society of General Internal Medicine 2013