CDC Grand Rounds：慢性疾患治療における服薬アドヒアランスの改善 ― 革新と機会

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ホーム IMICライブラリ MMWR抄訳 2017年（Vol.66)CDC Grand Rounds：慢性疾患治療にお･･･

MMWR抄訳

2017/11/17Vol. 66 / No. 45

MMWR66(45):1248－1251
CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management — Innovations and Opportunities

CDC Grand Rounds：慢性疾患治療における服薬アドヒアランスの改善 ― 革新と機会

アメリカでは年間に38億枚の処方箋が出されているが、約1/5は薬が出ておらず、また、薬が出されても約50％は、服薬のタイミング、量、頻度および期間などが不適切に使用されている。服薬違反による直接医療費は年間1,000億～3,000億ドルと推定されており、服薬アドヒアランスの改善は優先性が高く、経済的負担とともに慢性疾患による患者の負担も軽減される。服薬違反における患者側の要因には、飲み忘れや投与量、スケジュールの誤解などの非意図的要因、経済的理由、副作用、効果への期待からの服薬の中止やレジメンの変更などの意図的要因、さらに認知症、薬物依存、精神疾患など患者自身の障壁が挙げられる。供給者側の要因には、患者や介護者との連絡不足、複雑な投与レジメン、複数の供給者による調整不足など、さらにシステムやサービスに関する要因として供給者への利用制限、保険適用範囲、高額な医療費および自己負担金、不明瞭な添付文書などが挙げられる。これらを踏まえ、慢性疾患治療における服薬アドヒアランス改善のための革新的戦略として、1)医療提供者へのアクセス確保により治療の連続性を高め、チーム医療を実現する、2)患者の教育により、治療への意欲を高める、3)低コスト化、治療の継続または再開により薬剤入手の障害を抑制する、4)健康情報に関する技術的ツールを利用することで受診中または受診後の意思の決定やコミュニケーションを改善するなどが考えられる。

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