Fung Vicki, Huang Jie, Brand Richard, Newhouse Joseph P, Hsu John
Division of Research, Kaiser Permanente Medical Care Program, Oakland, California, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
Clin Ther. 2007 May;29(5):972-984. doi: 10.1016/j.clinthera.2007.05.010.
Despite substantial trial evidence that demonstrates the effectiveness of pharmacologic treatment for reducing blood pressure (BP) and cardiovascular events, many patients are nonadherent to their hypertension treatment.
The purpose of this study was to examine patient adherence to hypertension medications using pharmacy data (ie, outpatient, inpatient, and mail-order prescriptions) and the association between adherence measures and systolic BP (SBP) control.
The study included Medicare + Choice beneficiaries (aged > or = 65 years) who were continuously enrolled in an integrated delivery system in 2003, and who had documented hypertension and received > or = 1 hypertension drug in 2002. This analysis used automated clinical data and the 2000 US Census. We estimated 2 measures of hypertension treatment adherence in 2003 using the supply of dispensed drugs in days (proportion of days covered > or = 80%): (1) adherence to > or = 1 hypertension drug; and (2) adherence to the full hypertension treatment regimen. We defined the regimen by the number of hypertension drugs used concurrently in 2002. We assessed adherence annually and during the 30, 60, and 90 days before an SBP measurement. Logistic regression was used to examine the association between adherence and the number of drugs in the hypertension regimen, as well as the association between adherence and elevated SBP ( > or = 140 mm Hg). We adjusted for patient sociodemographic and clinical characteristics.
The majority (52.8%) of patients had multidrug hypertension regimens. In 2003, 87.3% of subjects were adherent to > or = 1 hypertension drug; 72.1% were adherent to their full regimen. After adjustment, we found that subjects with multidrug regimens were significantly more likely to be adherent to > or = 1 drug and significantly less likely to be adherent to their full regimen, compared with patients on a 1-drug regimen. Over one-third of subjects had elevated SBP in 2003. Both adherence measures were associated with lower odds of having elevated SBP (eg, odds ratio = 0.87 [95% CI, 0.84-0.89] for adherence to the full regimen). For subjects with multidrug regimens, partial adherence and nonadherence to the regimen were associated with higher odds of having elevated SBP.
Adherence measures using automated pharmacy data can identify patients who are nonadherent to their drug treatment regimen and who are more likely to have inadequately controlled BP. Adherence measures that account for the number of drugs in a patients' drug regimen might help identify additional patients at risk for poor BP outcomes due to partial treatment adherence.
尽管有大量试验证据表明药物治疗在降低血压（BP）和心血管事件方面有效，但许多患者并不坚持高血压治疗。
本研究的目的是利用药房数据（即门诊、住院和邮购处方）检查患者对高血压药物的依从性，以及依从性测量与收缩压（SBP）控制之间的关联。
该研究纳入了2003年持续参加综合医疗服务体系的医疗保险+选择计划受益人（年龄≥65岁），这些人在2002年有高血压记录且接受了≥1种高血压药物治疗。本分析使用了自动化临床数据和2000年美国人口普查数据。我们根据配发药物的供应天数（覆盖天数比例≥80%）估计了2003年高血压治疗依从性的两项指标：（1）对≥1种高血压药物的依从性；（2）对完整高血压治疗方案的依从性。我们根据2002年同时使用的高血压药物数量来定义治疗方案。我们每年以及在测量SBP前的30、60和90天评估依从性。使用逻辑回归来检查依从性与高血压治疗方案中药物数量之间的关联，以及依从性与SBP升高（≥140 mmHg）之间的关联。我们对患者的社会人口统计学和临床特征进行了调整。
大多数（52.8%）患者采用多药高血压治疗方案。2003年，87.3%的受试者对≥1种高血压药物依从；72.1%的受试者对其完整治疗方案依从。调整后，我们发现与采用单药治疗方案的患者相比，采用多药治疗方案的受试者对≥1种药物依从的可能性显著更高，而对其完整治疗方案依从的可能性显著更低。2003年超过三分之一的受试者SBP升高。两种依从性测量指标均与SBP升高的较低几率相关（例如，对完整治疗方案的依从性的优势比=0.87 [95% CI，0.84 - 0.89]）。对于采用多药治疗方案的受试者，部分依从和不依从治疗方案与SBP升高的较高几率相关。
使用自动化药房数据的依从性测量可以识别出不坚持药物治疗方案且更有可能血压控制不佳的患者。考虑患者药物治疗方案中药物数量的依从性测量可能有助于识别因部分治疗依从性而有血压不良结局风险的其他患者。
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