一项关于老年人抗高血压药物持续使用情况的跨国研究。
A cross-national study of the persistence of antihypertensive medication use in the elderly.
作者信息
van Wijk Boris L G, Shrank William H, Klungel Olaf H, Schneeweiss Sebastian, Brookhart M Alan, Avorn Jerry
机构信息
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. b.l.g
出版信息
J Hypertens. 2008 Jan;26(1):145-53. doi: 10.1097/HJH.0b013e32826308b4.
INTRODUCTION
Little is known about cross-national comparisons of the persistence of antihypertensive medication treatment, trends in persistence, and factors associated with persistence. The aim of this study was to describe and compare patterns of use of antihypertensive drugs in a population of elderly patients in the United States (Pennsylvania), Canada (British Columbia) and the Netherlands.
METHODS
A retrospective cohort study of Medicare enrollees in a state pharmacy assistance programme in Pennsylvania (USA), residents from British Columbia (Canada) and residents from the Netherlands registered in the PHARMO database was conducted. Each population included patients 65 years and older who were initiated on blood pressure-lowering treatment between 1 January 1998 and 31 December 2003 and who had continuous follow-up for at least 365 days. In these populations, the proportion of patients with at least 180 consecutive days without medication available (non-persistence) were identified as were predictors of non-persistence using Cox proportional hazards.
RESULTS
A total of 9664 Medicare enrollees (USA), 25 377 residents from British Columbia and 24 603 residents from the Netherlands were evaluated. During the first year after the initiation of treatment, the percentage of patients with at least 180 days without medication was 23.3% in Pennsylvania, 23.4% in British Columbia and 24.0% in the Netherlands. After 6 years, these percentages increased to 41.1, 36.3 and 38.2%, respectively. Factors associated with non-persistence were different between the three countries.
CONCLUSION
Despite differences in factors associated with persistence, non-persistence patterns are strikingly similar in all three populations. This suggests that the problem of non-persistence transcends international boundaries.
引言
关于抗高血压药物治疗持续性的跨国比较、持续性趋势以及与持续性相关的因素，我们了解得很少。本研究的目的是描述和比较美国（宾夕法尼亚州）、加拿大（不列颠哥伦比亚省）和荷兰老年患者群体中抗高血压药物的使用模式。
方法
对美国宾夕法尼亚州一个州药房援助项目中的医疗保险参保者、加拿大不列颠哥伦比亚省居民以及在PHARMO数据库中注册的荷兰居民进行了一项回顾性队列研究。每个群体都包括1998年1月1日至2003年12月31日开始接受降压治疗且持续随访至少365天的65岁及以上患者。在这些群体中，确定了至少连续180天无可用药物的患者比例（非持续性），并使用Cox比例风险模型确定了非持续性的预测因素。
结果
共评估了9664名美国医疗保险参保者、25377名不列颠哥伦比亚省居民和24603名荷兰居民。在治疗开始后的第一年，宾夕法尼亚州至少180天无药物的患者百分比为23.3%，不列颠哥伦比亚省为23.4%，荷兰为24.0%。6年后，这些百分比分别增至41.1%、36.3%和38.2%。三个国家与非持续性相关的因素有所不同。
结论
尽管与持续性相关的因素存在差异，但所有三个群体中的非持续性模式都惊人地相似。这表明非持续性问题超越了国界。
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