A cohort study of adherence to antidepressants in primary care: the influence of antidepressant concerns and treatment preferences.
A cohort study of adherence to antidepressants in primary care: the influence of antidepressant concerns and treatment preferences.
复制标题
一项关于初级保健中抗抑郁药物依从性的队列研究：抗抑郁药物关注和治疗偏好的影响。
DOI：
--
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
R. Churchill
中科院分区：
文献类型：
--
作者：
V. Hunot;R. Horne;M. Leese;R. Churchill
目的
临床指南建议，在抑郁症和焦虑症缓解后，应继续抗抑郁治疗至少6个月。然而，抗抑郁药的依从性很低。这项前瞻性队列研究调查了患者对抗抑郁药的担忧、治疗偏好和疾病感知对6个月内抗抑郁药依从性的影响。
方法
在英格兰东南部的5个初级保健实践中，前瞻性地随访了一组178名年龄在18至74岁之间的患者，这些患者新开具了抗抑郁药处方以治疗任何疾病。通过自我报告和处方续填数据测量依从性。在4个时间点，使用经验证的结局指标，药物信念问卷和疾病感知问卷对患者的感知进行量化。使用专门设计的调查问卷记录患者的治疗偏好。数据收集是在2000年9月至2002年5月期间进行的。
结果
在完成研究的147名参与者（83%）中，19%的人在整个6个月期间根据指南建议坚持服用抗抑郁药。对抗抑郁药副作用的特殊担忧（OR = 3.30，95%CI = 2.20 ~ 4.97）和对服用抗抑郁药的一般担忧（OR = 1.65，95%CI = 1.13 ~ 2.40）是不使用抗抑郁药的独立预测因素。对不同治疗的偏好/对首选治疗的不确定性也是一个强预测因子（OR = 3.82，95%CI = 1.35 - 10.77）。然而，疾病的看法是不相关的坚持。
结论
对抗抑郁药的担忧以及患者首选和处方治疗之间的不匹配是持续依从性的重大障碍。这项研究强调了患者-医生伙伴关系在探索抗抑郁药问题，治疗偏好和提供支持性持续管理方面的核心作用。这些发现可能会为初级保健计划中的干预措施的发展提供信息，以加强对常见精神障碍治疗的承诺。
OBJECTIVE
Clinical guidelines recommend that antidepressant treatment should be continued for a minimum of 6 months following response in depression and anxiety disorders. However, adherence to antidepressants is low. This prospective cohort study investigated the influence of patients' antidepressant concerns, treatment preferences, and illness perceptions on adherence to antidepressants over a 6-month period.
METHOD
A cohort of 178 patients aged 18 to 74 years and newly issued with a prescription for antidepressants to treat any condition was followed up prospectively at 5 primary care practices in Southeast England. Adherence was measured through self-report and prescription refill data. Patient perceptions were quantified using validated outcome measures, the Beliefs about Medicine Questionnaire and the Illness Perception Questionnaire, at 4 timepoints. Patient treatment preferences were recorded using a specially designed questionnaire. Data collection took place between September 2000 and May 2002.
RESULTS
Of 147 participants (83%) who completed the study, 19% persisted with antidepressants in accordance with guideline recommendations throughout the 6-month period. Specific concern about antidepressant side effects (OR = 3.30, 95% CI = 2.20 to 4.97) and general worry about taking antidepressants (OR = 1.65, 95% CI = 1.13 to 2.40) were independent predictors of antidepressant nonuse. Preference for different treatment/uncertainty about preferred treatment was also a strong predictor (OR = 3.82, 95% CI = 1.35 to 10.77). However, illness perceptions were not associated with adherence.
CONCLUSIONS
Concerns about antidepressants and a mismatch between patients' preferred and prescribed treatment act as significant barriers to sustained adherence. This study highlights the central role of the patient-physician partnership in exploring antidepressant concerns, working with treatment preferences, and providing supportive continued management. The findings may inform the development of interventions within primary care programs to enhance commitment to treatment for common mental disorders.
影响因子：
3.5
作者：
Bultman, DC;Svarstad, BL
通讯作者：
Svarstad, BL
影响因子：
17.7
作者：
Sirey, JA;Bruce, ML;Meyers, BS
通讯作者：
Meyers, BS