Partial compliance and risk of rehospitalization among California medicaid patients with schizophrenia
Partial compliance and risk of rehospitalization among California medicaid patients with schizophrenia
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DOI：
10.1176/appi.ps.55.8.886
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发表时间：
2004-08-01
影响因子：
3.8
通讯作者：
Locklear, J
中科院分区：
文献类型：
--
作者：
Weiden, PJ;Kozma, C;Locklear, J
目的：本研究的目的是评估一组加州医疗补助精神分裂症患者对抗精神病药物治疗方案的依从性与住院风险之间的关系。方法：通过对1999年至2001年期间4325名因治疗精神分裂症而服用抗精神病药物的门诊患者的加州医疗补助药房补药和医疗索赔的回顾，评估患者的遵医行为。依从性行为通过使用四种不同的定义来评估：药物治疗中的差距，药物的一致性和持久性，以及药物拥有率。患者被跟踪一年，平均有19.1次配药事件。使用使用每个依从性估计的Logistic回归模型来确定住院的几率。结果：住院风险与依从性显著相关。在所有定义中，依从性较低与较大的住院风险相关，高于住院的任何其他风险因素。例如，药物覆盖范围的任何缺口都与住院风险的增加有关，包括小至一到十天的缺口(优势比[OR]=1.98)。间隔11-30天的OR为2.81，间隔超过30天的OR为3.96。结论：这项研究表明，精神分裂症患者的部分依从性估计与住院风险之间存在直接的相关性。
Objective: The objective of this study was to evaluate the relationship between compliance with an antipsychotic medication regimen and risk of hospitalization in a cohort of California Medicaid patients with schizophrenia. Methods: Compliance behavior was estimated by using a retrospective review of California Medicaid pharmacy refill and medical claims for 4,325 outpatients for whom antipsychotics were prescribed for treatment of schizophrenia from 1999 to 2001. Compliance behavior was estimated by using four different definitions: gaps in medication therapy, medication consistency and persistence, and a medication possession ratio. Patients were followed for one year and had an average of 19.1 dispensing events. Logistic regression models using each compliance estimate were used to determine the odds of hospitalization. Results: Risk of hospitalization was significantly correlated with compliance. With all definitions, lower compliance was associated with a greater risk of hospitalization over and above any other risk factors for hospitalization. For example, the presence of any gap in medication coverage was associated with increased risk of hospitalization, including gaps as small as one to ten days (odds ratio [OR]=1.98). A gap of 11 to 30 days was associated with an OR of 2.81, and a gap of more than 30 days was associated with an OR of 3.96. Conclusions: This study showed a direct correlation between estimated partial compliance and hospitalization risk among patients with schizophrenia across a continuum of compliance behavior.