RT info:eu-repo/semantics/doctoralThesis
T1 Evaluación de la adherencia a psicofármacos: Estudio farmacoepidemiológico de registro en Castilla y León.
A1 Pedrosa Naudín, María Aránzazu
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Farmacología
K1 Adherence
K1 Adherencia
K1 Depression
K1 Depresión
K1 Dementia
K1 Demencia
K1 Drug utilization
K1 Uso de medicamentos
K1 32 Ciencias Médicas
AB INTRODUCTION: The use of antidepressants and anti-dementia drugs has increased in recent years. Patients with depression, anxiety, or dementia are more likely to not adhere to treatment. Non-adherence is associated with poorer health outcomes and increased morbidity and mortality. Additionally, nonadherence correlates with a considerable increase in healthcare costs.OBJECTIVES: 1) Evaluate non-adherence to antidepressants and anti-dementia drugs and analyze predisposing factors. 2) Evaluate the economic impact of nonadherence to antidepressants.METHODS: This was a population-based epidemiological registry study. Pharmaceutical consumption data was obtained from the pharmaceutical service information system in Castilla y León (CONCYLIA). An indirect method based on the medication possession ratio (MPR) was used to estimate adherence. Patients with an MPR<80% were considered non-adherent. Multivariate logistic regression was used to identify predictors of non-adherence while controlling for sociodemographic and clinical variables. Values of p < 0.05 were considered significant.RESULTS: In 2021, 10.6% of Castilla y León's population (246,718 individuals) consumed antidepressants, costing ¿29 million. The most used antidepressants were selective serotonin reuptake inhibitors (SSRIs) (54.77%) and "other antidepressants" (46.82%). Antidepressants were primarily prescribed for depression (36.73%) and anxiety (29.24%).The median annual cost of antidepressants per patient was ¿70.08. Patients' copayments accounted for 6.09% of the total cost, with a median of ¿2.78.Non-adherence to antidepressants was more prevalent among men (20.56%) than women (19.59%), decreasing with age. Non-adherence accounted for 13.30% of costs.Tricyclic antidepressants (TCAs) were associated with the highest prevalence of non-adherence (23.99%), followed by SSRIs (20.19%). Fluoxetine (23.53%) and fluvoxamine (22.42%) had the highest rates of non-adherence. Conversely, venlafaxine (14.64%) and citalopram (14.88%) had the lowest rates.Predictors of non-adherence to antidepressants included living in an urban area, taking TCAs, and having a neuropathic pain diagnosis. Non-adherence decreases with age. Protective factors include being female, institutionalization, polypharmacy, and having a diagnosis of depression or anxiety alongside another psychiatric diagnosis.In 2022, 6.12% of people over 80 years of age in Castile and León took anti-dementia drugs. The most used anti-dementia drugs were donepezil (43.49%) and rivastigmine (36.84%). Among this population, 14.7% used two or more different anti-dementia drugs. Most of these patients had multiple chronic conditions, including cardiovascular diseases (80%), depression/anxiety (60%), and psychotic disorders (39%).A total of 16.77% of patients were non-adherent to these medications, particularly rivastigmine. Memantine had the lowest rate of non-adherence (13.23%). Having multiple prescribers and using rivastigmine were predictors of non-adherence. In contrast, being institutionalized, taking multiple medications, the combined use of medications, the use of memantine, and having concomitant diagnoses such as psychotic disorders, depression, and Parkinson's disease were protective factors against non-adherence.CONCLUSIONS: MPR is a reliable indicator that helps clinicians identify non-adherent patients and take corrective action. Reducing nonadherence to psychotropic medications is essential for improving clinical and economic outcomes. There is an urgent need to implement standardized interventions and measures for the early detection of non-adherence, such as the indicator used in this study.
YR 2026
FD 2026
LK https://uvadoc.uva.es/handle/10324/83327
UL https://uvadoc.uva.es/handle/10324/83327
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 05-mar-2026