Lummis Heather L, Sketris Ingrid S, Gubitz Gordon J, Joffres Michel R, Flowerdew Gordon J
Pharmacy Department, Capital District Health Authority, Halifax, Canada.
BMC Neurol. 2008 Jul 10;8:25. doi: 10.1186/1471-2377-8-25.
Medication nonadherence can be as high as 50% and results in suboptimal patient outcomes. Stroke patients in particular can benefit from pharmacotherapy for thrombosis, hypertension, and dyslipidemia but are at high risk for medication nonpersistence.
Patients who were admitted to the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, with stroke between January 1, 2001 and December 31, 2002 were analyzed. Data collected were pre-stroke function, stroke subtype, stroke severity, patient outcomes, and medication use at discharge, and six and 12 months post discharge. Medication persistence at six and 12 months and the factors associated with nonpersistence at six months were examined using multivariable stepwise logistic regression.
At discharge, 420 patients (mean age 68.2 years, 55.7% male) were prescribed an average of 6.4 medications and mean prescription drug cost was $167 monthly. Antihypertensive (91%) and antithrombotic (96%) drug use at discharge were frequent, antilipidemic (73%) and antihyperglycemic (25%) drug use were less common. Self-reported persistence at six and 12 months after stroke was high (> 90%) for all categories. In the multivariable model of medication nonpersistence at six months, people aged 65 to 79 years were less likely to be nonpersistent with antihypertensive medications than people aged 80 years or more (Odds ratio (OR) 0.11, 95% Confidence Interval (CI) 0.03-0.39). Monthly drug costs of < $90 or $90-199.99 were associated with greater nonpersistence, compared to monthly drug costs > or =$200 (OR 6.74, 95% CI 1.32-34.46 for < $90; OR 5.25, 95% CI 1.14-24.25 for $90-199.99). For the antithrombotic drug category, people aged 65 to 79 years were less likely to be nonpersistent than people aged 80 years or more (OR 0.23, 95% CI 0.06-0.81), and people who were disabled before admission were more likely to be nonpersistent than those not disabled (OR 7.01, 95% CI 1.66-29.58).
Patients reported high medication persistence rates six and 12 months after stroke. Identification of factors associated with nonpersistence (such as older age and prior disability) will help predict which patients are at higher risk for discontinuing their medications.
药物治疗依从性差的情况高达50%，并导致患者预后不佳。尤其是中风患者可从针对血栓形成、高血压和血脂异常的药物治疗中获益，但药物治疗持续性差的风险很高。
对2001年1月1日至2002年12月31日期间在新斯科舍省哈利法克斯的伊丽莎白二世健康科学中心因中风入院的患者进行分析。收集的数据包括中风前功能、中风亚型、中风严重程度、患者预后以及出院时、出院后6个月和12个月的用药情况。使用多变量逐步逻辑回归分析6个月和12个月时的药物治疗持续性以及与6个月时治疗不持续相关的因素。
出院时，420名患者（平均年龄68.2岁，55.7%为男性）平均被开具6.4种药物，平均每月处方药费用为167美元。出院时使用抗高血压药物（91%）和抗血栓药物（96%）的情况很常见，使用抗血脂药物（73%）和抗高血糖药物（25%）的情况较少见。所有类别在中风后6个月和12个月时自我报告的治疗持续性都很高（>90%）。在6个月时药物治疗不持续的多变量模型中，65至79岁的人比80岁及以上的人更不容易出现抗高血压药物治疗不持续的情况（优势比（OR）0.11，95%置信区间（CI）0.03 - 0.39）。与每月药物费用>或 =200美元相比，每月药物费用<90美元或90 - 199.99美元与更高的治疗不持续性相关（每月费用<90美元时，OR 6.74，95% CI 1.32 - 34.46；每月费用90 - 199.99美元时，OR 5.25，95% CI 1.14 - 24.25）。对于抗血栓药物类别，65至79岁的人比80岁及以上的人更不容易出现治疗不持续的情况（OR 0.23，95% CI 0.06 - 0.81），入院前残疾的人比未残疾的人更有可能出现治疗不持续的情况（OR 7.01，95% CI 1.66 - 29.58）。
患者报告中风后6个月和12个月的药物治疗持续性率很高。识别与治疗不持续相关的因素（如年龄较大和既往残疾）将有助于预测哪些患者停药风险更高。
