Stern Lee, Berman Jeff, Lumry William, Katz Laura, Wang Lujing, Rosenblatt Lisa, Doyle John J
Global Health Outcomes, Analytica International, New York, New York 10016, USA.
Ann Allergy Asthma Immunol. 2006 Sep;97(3):402-8. doi: 10.1016/S1081-1206(10)60808-3.
Compliance with asthma medications probably results in improved outcomes, but few studies have examined this relationship.
To examine the association between medication compliance and exacerbation in asthmatic patients.
Retrospective analysis of a managed care database. The 97,743 participants (aged 6-99 years; mean age, 32.8 years) had asthma and prescriptions for controller medications. Compliance with the index medication (the first controller medication prescribed) was measured using 2 methods: medication possession ratio (MPR), calculated for 365 days after the index date, and number of prescriptions for each index medication. Exacerbation was defined as 1 or more emergency department visits or hospitalizations within 1 year of the index date. Multivariate models were used to determine the odds of exacerbation based on relative compliance for each definition of compliance.
Based on the median MPR, more-compliant patients were less likely to experience exacerbation than less-compliant patients (odds ratio, 0.94; 95% confidence interval, 0.91-0.97; P < .001). Using the 75th percentile MPR, risk of exacerbation was even smaller (odds ratio, 0.89; 95% confidence interval, 0.86-0.92; P < .001). All the cutoff points for compliance (> or = 2 through > or = 6 prescriptions) demonstrated significantly less exacerbations in more-compliant vs less-compliant patients after adjusting for covariates. As the criteria for compliance became more stringent, more-compliant patients became increasingly less likely to have an exacerbation vs less-compliant patients.
More-compliant asthmatic patients were significantly less likely to experience exacerbation than less-compliant asthmatic patients. These findings demonstrate the importance of improving medication compliance among asthmatic patients to impact outcomes.
依从哮喘药物治疗可能会改善治疗效果，但很少有研究探讨这种关系。
研究哮喘患者药物依从性与病情加重之间的关联。
对一个管理式医疗数据库进行回顾性分析。97743名参与者（年龄6至99岁；平均年龄32.8岁）患有哮喘且有控制药物的处方。使用两种方法衡量对索引药物（首次开具的控制药物）的依从性：药物持有率（MPR），在索引日期后365天计算；每种索引药物的处方数量。病情加重定义为在索引日期后1年内有1次或更多次急诊就诊或住院。使用多变量模型根据每种依从性定义的相对依从性来确定病情加重的几率。
基于MPR中位数，依从性较高的患者比依从性较低的患者病情加重的可能性更小（比值比，0.94；95%置信区间，0.91 - 0.97；P <.001）。使用第75百分位数的MPR，病情加重风险更小（比值比，0.89；95%置信区间，0.86 - 0.92；P <.001）。在调整协变量后，所有依从性的截断点（≥2至≥6张处方）显示，依从性较高的患者与依从性较低的患者相比，病情加重显著更少。随着依从性标准变得更加严格，依从性较高的患者与依从性较低的患者相比，病情加重的可能性越来越小。
依从性较高的哮喘患者比依从性较低的哮喘患者病情加重的可能性显著更小。这些发现表明提高哮喘患者的药物依从性对改善治疗效果的重要性。
