Depression, medication adherence, and service utilization in systemic lupus erythematosus.
Depression, medication adherence, and service utilization in systemic lupus erythematosus.
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DOI：
10.1002/art.24236
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发表时间：
2009-02-15
影响因子：
--
通讯作者：
Katz, Patricia
中科院分区：
文献类型：
--
作者：
Julian, Laura J.;Yelin, Edward;Yazdany, Jinoos;Panopalis, Pantelis;Trupin, Laura;Criswell, Lindsey A.;Katz, Patricia
忘记服药是不服药的一个重要原因。这项研究评估了参与加州大学旧金山分校狼疮结局研究(LOS)的系统性红斑狼疮(SLE)患者中与忘记服药有关的因素。依从性问题和服务利用(门诊就诊、急诊科就诊和住院)之间的关系也被评估。队列由834名LOS参与者组成，他们提供了自我报告的忘记按指导服药的频率。依从性和服务利用模式的预测因素包括自我报告的社会示意图、疾病相关特征(例如疾病活动、最近的系统性红斑狼疮发作)和心理健康特征(流行病学研究中心抑郁量表和认知功能筛查)。卫生保健利用模式包括去看风湿科医生、初级保健医生、其他护理提供者、急诊科和住院的存在和数量。在洛杉矶的队列中，46%的人报告说至少有时会忘记服药。在考虑了所有其他预测因素后，抑郁症状严重程度是坚持困难的强烈预测因素(优势比[OR]1.04，95%可信区间[95%CI]1.02-1.05；P<；0.0001)。报告依从性困难的患者有更多的风湿科门诊和初级保健就诊次数，并且更有可能去急诊科就诊(OR 1.45，95%CI 1.04~2.04；P=0.03)。抑郁症可能是服药依从性问题的一个重要原因，坚持服药的困难与高成本的服务利用，特别是急诊科就诊显著相关。在狼疮治疗方法迅速演变的时代，识别存在依从性问题风险的患者可能会减少医疗费用，改善SLE患者的预后。
Forgetting to take medications is an important cause of nonadherence. This study evaluated factors associated with forgetting to take medications in a large cohort of persons with systemic lupus erythematosus (SLE) participating in the University of California, San Francisco Lupus Outcomes Study (LOS). Relationships among adherence problems and service utilization (outpatient visits, emergency department visits, and hospitalizations) were also evaluated. The cohort consisted of 834 LOS participants who provided self-reported frequency of forgetting to take medications as directed. Predictors of adherence and service utilization patterns included self-reported sociodemo-graphics, disease-related characteristics (e.g., disease activity, recent SLE flare), and mental health characteristics (Center for Epidemiologic Studies Depression Scale and cognitive function screen). Health care utilization patterns included the presence and quantity of visits to rheumatologists, primary care physicians, other care providers, emergency departments, and hospitalizations. Forty-six percent of the LOS cohort reported forgetting to take medications at least some of the time. Depressive symptom severity was a strong predictor of adherence difficulties (odds ratio [OR] 1.04, 95% confidence interval [95% CI] 1.02–1.05; P < 0.0001) after accounting for all other predictors. Persons reporting adherence difficulties had significantly greater numbers of outpatient rheumatology and primary care visits, and were more likely to visit the emergency department (OR 1.45, 95% CI 1.04–2.04; P = 0.03). Depression may be an important cause of medication adherence problems, and difficulties with adherence are significantly associated with high-cost service utilization, specifically emergency department visits. In an era of rapidly evolving treatments for lupus, identifying patients at risk for adherence problems may decrease medical expenditures and improve patient outcomes in SLE.
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DOI：
10.1002/art.10790
发表时间：
2002-12-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Mosley-Williams, A;Lumley, MA;Guice, D
通讯作者：
Guice, D
影响因子：
5.9
作者：
Miller, Nancy Houston
通讯作者：
Miller, Nancy Houston
影响因子：
2.3
作者：
Burra, Tara A.;Chen, Edmund;Stewart, Donna E.
通讯作者：
Stewart, Donna E.
DOI：
10.1177/070674370605101110
发表时间：
2006-10-01
影响因子：
4
作者：
Bulloch, Andrew G.;Adair, Carol E.;Patten, Scott B.
通讯作者：
Patten, Scott B.
影响因子：
6.3
作者：
HELLER, RF;ROSE, G;CHRISTIE, DGS
通讯作者：
CHRISTIE, DGS