Robertson Teisha A, Cooke Catherine E, Wang Jingshu, Shaya Fadia T, Lee Helen Y
School of Pharmacy, University of Maryland, Baltimore, MD, USA.
Am J Manag Care. 2008 Nov;14(11):710-6.
To determine the effect of medication burden on persistent use of newly added lipid-lowering (LL) drugs among patients with hypertension.
This retrospective database study used medical and pharmacy claims from a mid-Atlantic managed care organization. The cohort was obtained from continuous member enrollment in pharmacy and medical benefits from January 1, 2003, to December 31, 2005.
Prescription claims were obtained for 18 months following the date of the first filled LL prescription (ie, index date). Patients were stratified into patients who changed LL drug or strength (group 1) and patients who did not change LL drug or strength (group 2). The primary outcome measure was persistence to newly added LL therapy. Persistence was defined by the length of time a member remained on therapy following the index date. The secondary outcome measure was the medication possession ratio (MPR). The MPR was calculated as the ratio of the sum of the days' supply of prescription filled divided by the number of days filled, plus the days' supply for the final prescription fill. Associations between the daily medication burden, defined as the number of unique drug products, and the outcome measures were analyzed.
In the cohort of 3058 patients, the mean medication burden was 2.9 medications. Medication burden was positively associated with persistence and MPR through 18 months. Patients who had greater medication burden had longer persistence (P <.001). Likewise, patients who had greater medication burden had higher MPRs and were more likely to be considered adherent (MPR, >80%) (P < .001 for both).
Patients with higher medication burden had greater adherence to newly added LL therapy. Medication burden should not deter clinicians from adding LL therapy. Among patients with added LL therapy, more attention should focus on patients who have changes to their LL regimen compared with patients who continue on the same LL prescription.
确定药物负担对高血压患者持续使用新添加降脂（LL）药物的影响。
这项回顾性数据库研究使用了来自大西洋中部一家管理式医疗组织的医疗和药房理赔数据。该队列来自2003年1月1日至2005年12月31日持续参保药房和医疗福利的成员。
在首次开具LL处方日期（即索引日期）后的18个月内获取处方理赔数据。患者被分为更换LL药物或剂量的患者（第1组）和未更换LL药物或剂量的患者（第2组）。主要结局指标是对新添加LL治疗的持续性。持续性定义为成员在索引日期后持续接受治疗的时间长度。次要结局指标是药物持有率（MPR）。MPR的计算方法是已填充处方的供应天数总和除以填充天数，再加上最后一次处方填充的供应天数。分析了定义为独特药品数量的每日药物负担与结局指标之间的关联。
在3058例患者的队列中，平均药物负担为2.9种药物。药物负担与18个月内的持续性和MPR呈正相关。药物负担较重的患者持续性更长（P<.001）。同样，药物负担较重的患者MPR更高，更有可能被视为依从性好（MPR>80%）（两者均P<.001）。
药物负担较高的患者对新添加的LL治疗依从性更高。药物负担不应阻止临床医生添加LL治疗。在接受LL治疗的患者中，与继续使用相同LL处方的患者相比，应更多关注其LL治疗方案有变化的患者
