Abstract：
ABSTRACTMedication nonadherence is common and results in avoidable morbidity, mortality, and burdens on healthcare systems. This paper proposes a preventative approach to medication nonadherence. We consider existing evidence on the prevalence and determinants of nonadherence early in a patient\'s medication-taking journey, and map these to potential opportunities for intervention. Many patients stop taking a new medication soon after they are prescribed it, often not collecting the medication. Early patterns of nonadherence are linked to later nonadherence via processes such as habit formation and symptom experiences. Known predictors of nonadherence may be present before someone starts a new treatment, when patients experience disruption to their lives and identity due to illness. Healthcare professionals typically have contact with patients around this time. We argue that it may be possible to prevent medication nonadherence: at the population level; by optimising the prescription process; and through low- and high-intensity interventions for patients with identified early barriers. We give examples of specific interventions and tools that might be needed to operationalise this approach in practice and propose new directions for research to promote early engagement with medication to prevent nonadherence.
摘要：
药物不依从是常见的，导致可避免的发病率，死亡率,和医疗系统的负担。本文提出了一种预防药物不依从性的方法。我们认为现有的证据表明，在患者服药的早期，不依从的患病率和决定因素，并将这些映射到潜在的干预机会。许多患者在开处方后不久就停止服用新药，经常不收集药物。早期的不坚持模式通过习惯形成和症状体验等过程与后来的不坚持相关联。在某人开始新的治疗之前，可能存在已知的非依从性预测因子，当病人经历中断他们的生活和身份由于疾病。医疗保健专业人员通常在这段时间与患者接触。我们认为，在人群水平上，通过优化处方过程，并通过对具有早期障碍的患者进行低强度和高强度干预，可以预防药物依从性。我们给出了具体的干预措施和工具的例子，可能需要在实践中操作这种方法，并提出了新的研究方向，以促进早期参与药物治疗，以防止不依从性。
