New Prescription Medication Gaps: A Comprehensive Measure of Adherence to New Prescriptions
New Prescription Medication Gaps: A Comprehensive Measure of Adherence to New Prescriptions
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DOI：
10.1111/j.1475-6773.2009.00989.x
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发表时间：
2009-10-01
影响因子：
3.4
通讯作者：
Selby, Joe V.
中科院分区：
文献类型：
--
作者：
Karter, Andrew J.;Parker, Melissa M.;Selby, Joe V.
目的描述一种综合总结药物依从性的新方法。研究设计在新的处方队列设计中（27,329名受试者开了新药），我们使用药房使用数据来评估24个月随访期间的依从性。使用一种新的测量方法（新处方药物间隔[NPMG]）来估计没有足够药物治疗的时间比例（药物间隔），并与传统的依从性测量方法进行比较。数据收集/提取方法数据来源于电子病历和调查回复。主要发现：22%的患者没有成为持续的使用者（没有或只有一次分配新处方）。新开处方的患者中，从未成为持续服用者的比例是持续服用者的8倍，但依从性不足。在24个月的随访中，至少有两次配药的患者中有4%停止了治疗。NPMG与高自付费用、自我报告的依从性和对治疗的临床反应显著相关。结论snpmg是一种有效的依从性措施。研究结果还表明，依从性不足的负担比以前认为的要大。公共卫生工作传统上侧重于改善正在使用的使用者的依从性；显然，需要更多的注意力来解决新药物开处方后最初阶段的非持续性问题。
ObjectiveDescribe a novel approach to comprehensively summarize medication adherence.Data Sources/Study SettingKaiser Permanente Northern California Diabetes Registry (n similar to 220,000)Study DesignIn a new prescription cohort design (27,329 subjects prescribed new medications), we used pharmacy utilization data to estimate adherence during 24 months follow-up. Proportion of time without sufficient medications (medication gaps) was estimated using a novel measure (New Prescription Medication Gaps [NPMG]) and compared with a traditional measure of adherence.Data Collection/Extraction MethodsData derived from electronic medical records and survey responses.Principal FindingsTwenty-two percent of patients did not become ongoing users (had zero or only one dispensing of the new prescription). The proportion of newly prescribed patients that never became ongoing users was eightfold greater than the proportion who maintained ongoing use, but with inadequate adherence. Four percent of those with at least two dispensings discontinued therapy during the 24 months follow-up. NPMG was significantly associated with high out-of-pocket costs, self-reported adherence, and clinical response to therapy.ConclusionsNPMG is a valid adherence measure. Findings also suggest a larger burden of inadequate adherence than previously thought. Public health efforts have traditionally focused on improving adherence in ongoing users; clearly more attention is needed to address nonpersistence in the very first stages after a new medication is prescribed.