Can we identify clinical predictors of medication adherence... and should we?
Can we identify clinical predictors of medication adherence... and should we?
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我们能否确定药物依从性的临床预测因素……我们应该吗？
DOI：
10.1097/mlr.0b013e3181d51ddf
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发表时间：
2010
期刊：
影响因子：
3
通讯作者：
Steiner,JohnF
中科院分区：
文献类型：
--
作者：
Steiner,JohnF
由于服药依从性差会导致健康状况恶化，临床医生长期以来一直在寻找不按处方服药的患者。早期的依从性研究表明，临床医生不能单独使用他们的主观判断来预测哪些患者会依从。 1 尽管临床无所不知的神话很容易被消除，但研究人员一直坚持尝试确定社会人口统计学和临床特征的概况，以识别不依从风险特别高的患者。对这些大量且常常相互矛盾的文献的总结得出的结论是，很少有临床特征与不依从性密切相关。 2尽管有这一结论，寻求将临床变量与不依从性联系起来的论文仍在不断出现。 3-5 为什么研究人员继续进行这一研究？部分原因是因为他们可以。记录配药日期和数量的大型药房数据库是关于遵守处方补充的诱人信息来源，这是服用这些药物的必要前提。基于药房的依从性测量与其他依从性测量（例如药丸计数和自我报告）、药物作用的生理测量（例如血压控制和胆固醇降低）以及临床结果（例如死亡和住院治疗）显着相关。 6, 7 将药房信息与包含患者特征、索赔数据或大型交付系统（例如健康维护组织、退伍军人事务部、州医疗补助计划和私人保险计划）中的临床记录的其他数据库连接起来，可以对数以万计的个人进行补充用药依从性的流行病学研究。如此大规模的研究几乎不可避免地会证明患者个体特征与补充依从性之间存在统计学上显着的关联。
Because low adherence with medications worsens health outcomes, clinicians have long sought to identify patients who do not take their medications as prescribed. Early adherence research demonstrated that clinicians could not use their subjective judgments alone to predict which of their patients would adhere. 1 Although the myth of clinical omniscience was easily dispelled, researchers have persisted in attempts to identify a profile of socio-demographic and clinical characteristics that would identify patients at particularly high risk of nonadherence. Summaries of this vast and often contradictory literature have concluded that few clinical characteristics are strongly associated with nonadherence. 2Despite this conclusion, papers that seek to associate clinical variables with nonadherence continue to appear. 3–5 Why do researchers continue this line of research? In part, it is because they can. Large pharmacy databases that record the date and quantity of medications dispensed are a tempting source of information about adherence with prescription refills, a necessary precursor to taking those medications. Pharmacy-based adherence measures correlate significantly with other adherence measures such as pill counts and self-report, with physiological measures of drug effect (such as blood pressure control and cholesterol reduction) and with clinical outcomes such as death and hospitalization. 6, 7 Linkage of pharmacy information to other databases containing patient characteristics, claims data, or clinical records in large delivery systems such as health maintenance organizations, the Department of Veterans Affairs, state Medicaid programs and private insurance plans, allows epidemiological studies of refill adherence in tens of thousands of individuals. Studies of this magnitude will almost inevitably demonstrate statistically significant associations between individual patient characteristics and refill adherence.
药物不依从性对糖尿病患者住院和死亡率的影响
DOI：
10.1016/s0084-3741(08)70021-0
发表时间：
2007
期刊：
Yearbook of Endocrinology
影响因子：
--
作者：
L. Kennedy
通讯作者：
L. Kennedy
预测家庭实践中地高辛治疗方案的依从性。
影响因子：
14.6
作者：
J. R. Gilbert;C. E. Evans;R. Haynes;P. Tugwell
通讯作者：
P. Tugwell