Balkrishnan R, Christensen D B
Section on Social Sciences and Health Policy, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Clin Ther. 2000 Apr;22(4):452-69. doi: 10.1016/S0149-2918(00)89013-X.
This study was undertaken to examine the impact of select demographic, clinical, and medication-related factors on elderly patients' medication adherence to inhaled corticosteroid therapy. It also examined the impact of medication adherence on health outcomes and on health care service utilization and costs.
Asthma in the elderly is a growing concern because of its increasing prevalence and the increase in asthma-related deaths. Poor medication utilization could be contributing to this trend in the elderly population and should be examined.
This retrospective, longitudinal, 2-year cohort study included 1595 patients aged > or =65 years with moderate to severe chronic pulmonary disease who were enrolled in a health maintenance organization. The study used sequential regression analyses to model (1) medication adherence and (2) health care service utilization and charges as functions of adherence.
With other factors controlled for, this study found that clinical and medication-related variables including comorbidities, additional complications, and number of medications were predictive of adherence to prophylactic inhaled corticosteroid therapy in this population. Poorer medication adherence was associated with a 5% increase in total annual physician visits (P < 0.05). Better medication adherence was associated with a 20% decrease in annual hospitalization (P < 0.05). Additional pulmonary complications and severe comorbidities were associated with increases in health care utilization and costs. Patients with better adherence to prophylactic therapy were few, and the beneficial effects of better adherence were not significant when the population averages were considered.
The results of this study indicated that the beneficial effects of better adherence to prophylactic inhaled corticosteroid therapy tended to diminish in a population with relatively poor medication adherence. Findings of this study support a policy of selectively targeting elderly patients at risk for morbidity and implementing monitoring, education, and management programs to increase medication-adherence behavior. This policy could lead to optimal resource utilization and management of chronic pulmonary disease.
本研究旨在探讨特定的人口统计学、临床和药物相关因素对老年患者吸入糖皮质激素治疗用药依从性的影响。同时，研究用药依从性对健康结局以及医疗服务利用和成本的影响。
由于老年哮喘患病率不断上升以及哮喘相关死亡人数增加，老年哮喘问题日益受到关注。用药不当可能是导致老年人群这一趋势的原因之一，因此需要对此进行研究。
这项回顾性、纵向、为期2年的队列研究纳入了1595名年龄≥65岁、患有中度至重度慢性肺部疾病且加入了健康维护组织的患者。该研究采用逐步回归分析来构建模型：（1）用药依从性；（2）医疗服务利用和费用作为依从性的函数。
在控制了其他因素后，本研究发现临床和药物相关变量，包括合并症、额外并发症和用药数量，可预测该人群预防性吸入糖皮质激素治疗的依从性。用药依从性较差与每年门诊就诊总次数增加5%相关（P<0.05）。用药依从性较好与每年住院次数减少20%相关（P<0.05）。额外的肺部并发症和严重合并症与医疗服务利用和成本增加相关。预防性治疗依从性较好的患者较少，从总体平均水平来看，依从性提高的有益效果并不显著。
本研究结果表明，在用药依从性相对较差的人群中，更好地依从预防性吸入糖皮质激素治疗的有益效果往往会减弱。本研究结果支持一项政策，即有针对性地关注有发病风险的老年患者，并实施监测、教育和管理项目以提高用药依从行为。该政策可能会实现慢性肺部疾病资源的优化利用和管理。
