Does Adherence to Medications for Type 2 Diabetes Differ Between Individuals With Vs Without Schizophrenia?
Does Adherence to Medications for Type 2 Diabetes Differ Between Individuals With Vs Without Schizophrenia?
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DOI：
10.1093/schbul/sbn106
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发表时间：
2010-03-01
影响因子：
6.6
通讯作者：
Valenstein, Marcia
中科院分区：
文献类型：
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作者：
Kreyenbuhl, Julie;Dixon, Lisa B.;Valenstein, Marcia
精神分裂症患者的健康状况不佳和死亡的风险增加。这可能是由于并发症的自我管理不足，如2型糖尿病。我们比较了患有精神分裂症的糖尿病患者与没有精神分裂症的糖尿病患者口服降糖药的依从性。使用退伍军人事务部（VA）的卫生系统管理数据，我们确定了所有患者的精神分裂症和2型糖尿病，至少有一个口服降糖药处方填写在2002年财政年度（N = 11 454）和对照组的糖尿病患者谁没有被诊断为精神分裂症（N = 10 560）。不依从的操作有一个药物占有率表明收到低于80%的所需的降糖药物。有精神分裂症的糖尿病患者依从性差的发生率（43%）低于无精神分裂症的糖尿病患者（52%，P <0.001）。在多变量分析中，与未患精神分裂症相比，患有精神分裂症与依从性差的可能性降低25%相关（校正比值比：0.75，95%置信区间：0.70-0.80）。服药依从性与黑人种族、无家可归、抑郁、物质使用障碍和医疗合并症有关。更多的门诊就诊、更高比例的邮寄处方、更低的处方自付额和更复杂的药物治疗方案均与依从性增加相关。在接受持续VA护理的糖尿病退伍军人中，总体降糖药物依从性较低，但合并精神分裂症的个体更有可能依从这些药物。未来的研究应调查是否因素，如慢性精神疾病的comanabiliary或定期接触精神卫生提供者赋予糖尿病自我管理的好处精神分裂症患者。
Individuals with schizophrenia are at increased risk for poor health outcomes and mortality. This may be due to inadequate self-management of co-occurring conditions, such as type 2 diabetes. We compared adherence to oral hypoglycemic medications for diabetes patients with vs without comorbid schizophrenia. Using Veterans Affairs (VA) health system administrative data, we identified all patients with both schizophrenia and type 2 diabetes and with at least one oral hypoglycemic prescription fill in fiscal year 2002 (N = 11 454) and a comparison group of patients with diabetes who were not diagnosed with schizophrenia (N = 10 560). Nonadherence was operationalized as having a medication possession ratio indicating receipt of less than 80% of needed hypoglycemic medications. Poor adherence was less prevalent among diabetes patients with (43%) than without schizophrenia (52%, P < .001). In multivariable analyses, having schizophrenia was associated with a 25% lower likelihood of poor adherence compared with not having schizophrenia (adjusted odds ratio: 0.75, 95% confidence interval: 0.70-0.80). Poorer adherence was associated with black race, homelessness, depression, substance use disorder, and medical comorbidity. Having more outpatient visits, a higher proportion of prescriptions delivered by mail, lower prescription copayments, and more complex medication regimens were each associated with increased adherence. Among veterans with diabetes receiving ongoing VA care, overall hypoglycemic medication adherence was low, but individuals with comorbid schizophrenia were more likely to be adherent to these medications. Future studies should investigate whether factors such as comanagement of a chronic psychiatric illness or regular contact with mental health providers bestow benefits for diabetes self-management in persons with schizophrenia.