榮民醫院門診精神分裂症患者之服藥順從性   全文下載

Medication Compliance in Outpatients with Schizophrenia in One Veterans Hospital in Taiwan

對精神分裂症治療而言，患者之服藥順從性為決定治療結果的重要因素之一。本研究調查接受單一抗精神病藥物治療之門診精神分裂症病患之服藥順從性，比較第一代及第二代抗精神病藥物及其它因素對服藥順從性的影響。本計畫選取玉里榮民醫院正在接受單一第一代或第二代口服抗精神病藥物治療之慢性精神分裂症之門診患者，針對病患之服藥狀況、人口學資料、社會支持、與藥物治療相關之不良反應與治療利益進行訪問，並訪問受訪者之醫師有關受訪者之服藥狀況、Clinical Global Impression（CGI）及是否有其它精神疾病。較佳之服藥順性之定義為在受訪前一個月內服用超過75%之藥物。在76位病患中，39位接受第二代抗精神藥物治療（amisulpride 、risperidone或olanzapine），37位接受第一代抗精神藥物治療（haloperidol或sulpiride）。有38位在受訪前一個月內服用超過75%之藥物，病患平均年齡為41 歲，62%為男性。不同服藥順從性在教育程度與工作與否有顯著差異。以logistic regression model分析結果顯示服用第一代或第二代抗精神病藥物與較佳之服藥順從性並無相關性。較高的教育程度與較佳之服藥順從性有顯著相關性，工作與藥物治療利益則與較佳之服藥順從性有邊際顯著相關性。

Medication compliance is an important determinant in schizophrenia treatment outcomes. This study aimed to investigate medication compliance in cases of patients receiving a single antipsychotic medication among adult outpatients with schizophrenia, and examine whether their antipsychotic therapy and other factors may affect the medication compliance. Subjects with schizophrenia who had received any single outpatient first- or second-generation antipsychotic therapy from the Yuli Veterans Hospital, Taiwan, during August and November 2006 were identified from medical chart reviews. The selected subjects were surveyed for information including their medication compliance, sociodemographics, treatment-related side effects, social support, and perceived treatmentrelated benefits. Their physicians were also surveyed on their medication compliance, Clinical Global Impression (CGI) scores, and comorbid mental illness(es). Good medication compliance was defined as consumption of more than 75% of prescribed antipsychotics in the previous month. Subjects were categorized into this group when both their self-reported consumption and their physicians’ estimation were higher than 75%. A logistic regression model was adopted to evaluate the association of each factor with medication compliance. Of the 76 subjects surveyed, 39 (51%) received second-generation antipsychotics (amisulpride, risperidone, or olanzapine), while 37 (49%) received first-generation antipsychotics (haloperidol or sulpiride). Thirty-eight (50%) consumed more than 75% of prescribed medications in the previous month. The average age was 41, and 62% of the sample was male. Education level and employment type were significantly different between individuals with good and poor medication compliance. The regression result indicated that education of above nine years was significantly associated with an increased likelihood of good medication compliance. Employment and perceived treatment benefits were marginally significantly correlated with good medication compliance. Second-generation antipsychotics, however, had no correlation with good medication compliance.