七种不同疾病患者的药物依从率比较。
Comparison of drug adherence rates among patients with seven different medical conditions.
作者信息
Briesacher Becky A, Andrade Susan E, Fouayzi Hassan, Chan K Arnold
机构信息
Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Meyers Primary Care Institute, Worcester, MA 01605, USA.
出版信息
Pharmacotherapy. 2008 Apr;28(4):437-43. doi: 10.1592/phco.28.4.437.
STUDY OBJECTIVE
To compare drug adherence rates among patients with gout, hypercholesterolemia, hypertension, hypothyroidism, osteoporosis, seizure disorders, and type 2 diabetes mellitus by using a standardized approach.
DESIGN
Longitudinal study.
DATA SOURCE
Health care claims data from 2001-2004.
PATIENTS
A total of 706,032 adults aged 18 years or older with at least one of the seven medical conditions and with incident use of drug therapy for that condition.
MEASUREMENTS AND MAIN RESULTS
Drug adherence was measured as the sum of the days' supply of drug therapy over the first year observed. Covariates were age, sex, geographic residence, type of health plan, and a comorbidity score calculated by using the Hierarchical Condition Categories risk adjuster. Bivariate statistics and stratification analyses were used to assess unadjusted means and frequency distributions. Sample sizes ranged from 4984 subjects for seizure disorders to 457,395 for hypertension. During the first year of drug therapy, 72.3% of individuals with hypertension achieved adherence rates of 80% or better compared with 68.4%, 65.4%, 60.8%, 54.6%, 51.2%, or 36.8% for those with hypothyroidism, type 2 diabetes, seizure disorders, hypercholesterolemia, osteoporosis, or gout, respectively. Age younger than 60 years was associated with lower adherence across all diseases except seizure disorders. Comorbidity burden and adherence varied by disease. As comorbidity increased, adherence among subjects with osteoporosis decreased, whereas adherence among those with hypertension, hypercholesterolemia, or gout increased. Add-on drug therapies and previous experience with taking drugs for the condition increased adherence among subjects with hypertension, type 2 diabetes, hypothyroidism, or seizure disorders but not the other conditions.
CONCLUSION
This uniform comparison of drug adherence revealed modest variation across six of seven diseases, with the outlier condition being gout.
研究目的
采用标准化方法比较痛风、高胆固醇血症、高血压、甲状腺功能减退、骨质疏松症、癫痫症和2型糖尿病患者的药物依从率。
设计
纵向研究。
数据来源
2001 - 2004年的医疗保健理赔数据。
患者
共有706,032名18岁及以上的成年人，患有七种疾病中的至少一种，并首次因该疾病接受药物治疗。
测量指标及主要结果
药物依从性通过观察的第一年药物治疗供应天数总和来衡量。协变量包括年龄、性别、地理居住区域、健康计划类型，以及使用分层条件分类风险调整器计算的合并症评分。采用双变量统计和分层分析来评估未调整的均值和频率分布。样本量从癫痫症的4984名受试者到高血压的457,395名受试者不等。在药物治疗的第一年，高血压患者中有72.3%的人依从率达到80%或更高，相比之下，甲状腺功能减退、2型糖尿病、癫痫症、高胆固醇血症、骨质疏松症或痛风患者的依从率分别为68.4%、65.4%、60.8%、54.6%、51.2%或36.8%。除癫痫症外，60岁以下的年龄与所有疾病的较低依从性相关。合并症负担和依从性因疾病而异。随着合并症增加，骨质疏松症患者的依从性下降，而高血压、高胆固醇血症或痛风患者的依从性增加。附加药物治疗和既往治疗该疾病的经验增加了高血压、2型糖尿病、甲状腺功能减退或癫痫症患者的依从性，但对其他疾病患者无效。
结论
这种对药物依从性的统一比较显示，七种疾病中的六种存在适度差异，痛风为异常情况。
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