Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication
Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication
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DOI：
10.1370/afm.238
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发表时间：
2005-01-01
影响因子：
4.4
通讯作者：
Schwenk, TL
中科院分区：
文献类型：
--
作者：
Aikens, JE;Nease, DE;Schwenk, TL
本研究旨在确定在抗抑郁药治疗的维持阶段，即症状和方案稳定后，治疗依从性的人口统计学、精神病学和态度预测因素。方法我们调查了81例接受维持抗抑郁药治疗的初级保健患者的一般依从性、最近漏服剂量、抑郁和治疗特征、用药信念（必要性，关注，危害性和过度处方）和其他变量。额外的数据收集从医疗和支付records.Results治疗时间中位数为75周。依从性和信念广泛分散，与治疗持续时间和类型，身体功能和人口统计学无关。多变量分析调整社会期望，抑郁症的严重程度，治疗持续时间表明，抗抑郁药的具体的“必要性减关注”的复合材料与这两个依从性的结果密切相关。具体而言，当需要超过关注时，遵守率最高，当关注超过需要时，遵守率最低。我们将这两个维度交叉起来，描述了4种患者对抗抑郁药的态度：怀疑、冷漠、矛盾和接受。结论：接受抗抑郁药维持治疗的患者在依从性方面差异很大。这种差异主要是由他们对抗抑郁药物的需求和危害性的看法之间的平衡来解释的，即当感知的危害超过感知的需求时，依从性最低，而当感知的需求超过感知的危害时，依从性最高。我们推测的方法来定制的坚持策略，病人的信念。随后的研究应该确定患者对药物的看法是否可以预测抑郁症的结果，是否可以用于改善临床管理，以及是否对行为干预做出反应。
PURPOSE This study aimed to identify the demographic, psychiatric, and attitudinal predictors of treatment adherence during the maintenance phase of antidepressant treatment, ie, after symptoms and regimen are stabilized.METHODS We surveyed 81 primary care patients given maintenance antidepressant medications regarding general adherence, recent missed doses, depression and treatment features, medication beliefs (necessity, concerns, harmfulness, and overprescription), and other variables. Additional data were collected from medical and payer records.RESULTS Median treatment duration was 75 weeks. Adherence and beliefs were broadly dispersed and unrelated to treatment duration and type, physical functioning, and demographics. Multivariate analysis adjusting for social desirability, depression severity, and treatment duration indicated that an antidepressant-specific "necessity-minus-concerns" composite was strongly associated with both adherence outcomes. Specifically, adherence was highest when necessity exceeded concerns and lowest when concerns exceeded necessity. We crossed these 2 dimensions to characterize 4 patient attitudes toward antidepressants: skepticism, indifference, ambivalence, and acceptance..CONCLUSIONS Patients given maintenance antidepressants vary widely in adherence. This variation is primarily explained by the balance between their perceptions of need and harmfulness of antidepressant medication, in that adherence is lowest when perceived harm exceeds perceived need, and highest when perceived need exceeds perceived harm. We speculate on ways to tailor adherence strategies to patient beliefs. Subsequent research should determine whether patients' perceptions about medication predict depression outcomes, can be used to improve clinical management, and respond to behavioral intervention.