The Unmet Challenge of Medication Nonadherence.
The Unmet Challenge of Medication Nonadherence.
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DOI：
10.7812/tpp/18-033
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发表时间：
2018-01-01
影响因子：
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通讯作者：
Kleinsinger, Fred
中科院分区：
文献类型：
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作者：
Kleinsinger, Fred
慢性病患者的药物不依从性非常常见，影响多达40%至50%的患者，这些患者被处方药物用于管理慢性疾病，如糖尿病或高血压。这种不遵守规定的治疗被认为每年至少造成10万例可预防的死亡和1000亿美元的可预防的医疗费用。尽管如此，医学界在很大程度上忽视了药物不依从性，或者将其视为患者问题，而不是医生或卫生系统问题。大部分关于不依从性的文献都集中在依从性的障碍上，并假设适当的依从性是正常的事件过程，而不依从性是一种失常。这种方法最小化和过度简化了问题。对人类来说，改变自己的行为并不容易，即使是许多医生认为是微小的改变，比如服用处方药。改善药物依从性尚未得到很好的研究，但科克伦综述表明，多因素干预更有效。在至少一个综合医疗保健系统中，北方加州的Kaiser Permanente，以电子健康记录为中心的方法组合将药物依从率提高到80%以上。在其他卫生保健系统中使用类似的要素是可行的，但需要动机和规划。除非关键参与者决定接受这一挑战，并改变报销制度，以奖励改善药物依从性和慢性病控制的卫生系统，否则不会发生有效的变化。
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions such as diabetes or hypertension. This nonadherence to prescribed treatment is thought to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year. Despite this, the medical profession largely ignores medication nonadherence or sees it as a patient problem and not a physician or health system problem. Much of the literature on nonadherence focuses on barriers to adherence, with the assumption that appropriate adherence is the normal course of events and nonadherence is an aberration. This approach minimizes and oversimplifies the problem. It is not easy for humans to change their behavior, even for what many physicians see as a minor change such as taking prescription medications. Improving medication adherence has not been well studied, but a Cochrane review shows that multifactorial interventions are more effective. In at least one integrated health care system, Kaiser Permanente Northern California, a combination of approaches centered on the electronic health record has improved medication adherence rates to above 80%. Using similar elements would be feasible in other health care systems but would require motivation and planning. Effective change will not happen until key players decide to take on this challenge and reimbursement systems are changed to reward health systems that improve medication adherence and chronic disease control.