Marrs Joel C, Saseen Joseph J
Department of Pharmacy Practice, Oregon State University, Portland, Oregon, USA.
Pharmacotherapy. 2008 May;28(5):562-9. doi: 10.1592/phco.28.5.562.
To compare dyslipidemia management with statin-based therapy in insured patients versus indigent patients receiving medication assistance, and to determine drug therapy adherence rates in the two groups.
Retrospective medical record review. Setting. University-based health care system.
Two hundred forty patients with dyslipidemia who received statin-based therapy from the outpatient pharmacies and clinical care at an affiliated clinic.
Prescription records identified 665 patients between October 1, 2004, and September 30, 2005. Forty of these patients had insurance (with a single carrier), and the remaining 625 patients received health care subsidies from the Colorado Indigent Care Program (CICP). Using a block scheme, 200 patients from the CICP were randomly extracted. The primary objective was measured by assessment of low-density lipoprotein cholesterol (LDL) goal attainment and use of a moderate-potency, lipid-lowering regimen capable of achieving an LDL level reduction of least 30%. Of a total of 240 patients who met study criteria, 26 were excluded whose records lacked LDL measurements while receiving therapy. The LDL goal was achieved in 122 (68.9%) of the 177 patients in the CICP group versus 29 (78.4%) of the 37 patients in the insured group (p=0.34). A moderate-potency, LDL-lowering regimen was used by 90.5% of 200 patients in the CICP group and 85% of 40 patients in the insured group (p=0.45). In patients classified as having moderately high, high, or very high cardiovascular risk, LDL goals were attained in 103 (67.3%) of 153 patients in the CICP group versus 16 (69.6%) of 23 patients in the insured group (p=0.83). In this higher-risk subgroup, a moderate-potency regimen was used in 162 (92.6%) of 175 patients in the CICP group versus 23 (92%) of 25 patients in the insured group (p=0.92). Among the very high-risk patients from the two groups combined, 30 (52.6%) of 57 patients achieved LDL concentrations below 70 mg/dl, and 58 (95.1%) of 61 patients were administered a moderate-potency, LDL-lowering regimen. The secondary objective, overall adherence, as assessed by the medication possession ratio, was better in the CICP group than in the insured group.
Our data suggest that quality of dyslipidemia management is similar for indigent and insured populations. Overall LDL goal attainment rates were higher than those reported in the literature. Most patients with significant cardiovascular risk, including those at very high risk, were treated according to established guidelines. Adherence rates were greater for indigent patients.
比较接受他汀类药物治疗的参保患者与接受药物援助的贫困患者的血脂异常管理情况，并确定两组的药物治疗依从率。
回顾性病历审查。地点：基于大学的医疗保健系统。
240例接受他汀类药物治疗且在附属诊所接受门诊药房和临床护理的血脂异常患者。
处方记录显示，在2004年10月1日至2005年9月30日期间有665例患者。其中40例患者有保险（由单一承保公司承保），其余625例患者接受科罗拉多贫困医疗计划（CICP）的医疗补贴。采用分组方案，从CICP中随机抽取200例患者。主要目标通过评估低密度脂蛋白胆固醇（LDL）目标达成情况以及使用能够使LDL水平降低至少30%的中效降脂方案来衡量。在符合研究标准的240例患者中，有26例被排除，其记录显示在接受治疗时缺乏LDL测量值。CICP组177例患者中有122例（68.9%）达到LDL目标，而参保组37例患者中有29例（78.4%）达到目标（p = 0.34）。CICP组200例患者中有90.5%使用了中效LDL降低方案，参保组40例患者中有85%使用了该方案（p = 0.45）。在被分类为具有中度高、高或非常高心血管风险的患者中，CICP组153例患者中有103例（67.3%）达到LDL目标，参保组23例患者中有16例（69.6%）达到目标（p = 0.83）。在这个高风险亚组中，CICP组175例患者中有162例（92.6%）使用了中效方案，参保组25例患者中有23例（92%）使用了该方案（p = 0.92）。在两组合并的极高风险患者中，57例患者中有30例（52.6%）的LDL浓度低于70mg/dl，61例患者中有58例（95.1%）接受了中效LDL降低方案。次要目标，即通过药物持有率评估的总体依从性，CICP组优于参保组。
我们的数据表明，贫困人群和参保人群的血脂异常管理质量相似。总体LDL目标达成率高于文献报道。大多数有显著心血管风险的患者，包括那些极高风险的患者，均按照既定指南接受治疗。贫困患者的依从率更高。
