Nichol Michael B, Knight Tara K, Wu Joanne, Barron Richard, Penson David F
Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, California 90089, USA.
J Urol. 2009 May;181(5):2214-21; discussion 2221-2. doi: 10.1016/j.juro.2009.01.033. Epub 2009 Mar 17.
We investigated adherence to benign prostatic hyperplasia medications in a California Medicaid population.
Using California Medicaid data on 1995 to 2004 we identified adult males 40 years old or older with 1 or more diagnosis and 2 or more prescription fills for benign prostatic hyperplasia. Patients with 2 fills on the same day were assigned to the multiple medication cohort. Adherence was measured using the medication possession ratio for the index medication and the proportion of days covered for any benign prostatic hyperplasia medication. Patients with a medication possession ratio or proportion of days covered of 0.8 or greater were considered adherent. A Cox proportional hazards model was used to assess the relative hazards associated with discontinuation. Multiple logistic regression was used to investigate factors associated with nonadherence or a benign prostatic hyperplasia related procedure.
Of the total population of 2,640 men 40% were adherent with any benign prostatic hyperplasia medication. A significantly greater proportion of patients using multiple medications and finasteride were adherent with any benign prostatic hyperplasia medication (62% and 55%, respectively, p <0.0001). Doxazosin, terazosin and tamsulosin use was associated with nonadherence (p = 0.008, 0.04 and 0.03, respectively). Younger patients and those changing medications were more likely to discontinue (p = 0.01 and <0.0001), while patients using multiple medications and those experiencing a gap were at lower risk for discontinuation (p = 0.01 and <0.0001, respectively). Predictors of a procedure included an index prescription in 1999 or later, a urologist visit and nonadherence to any benign prostatic hyperplasia medication (p = 0.01, <0.0001 and <0.0001, respectively).
Adherence to alpha-blockers was less than adherence to finasteride or multiple medications and nonadherence was significantly associated with a procedure. Interventions focused on improving adherence to benign prostatic hyperplasia medications are clearly needed.
我们对加利福尼亚医疗补助人群中良性前列腺增生症药物的依从性进行了调查。
利用1995年至2004年加利福尼亚医疗补助数据，我们确定了年龄在40岁及以上、有1项或更多诊断且有2次或更多次良性前列腺增生症处方配药的成年男性。同一天有2次配药的患者被归入多药治疗队列。使用索引药物的药物持有率和任何良性前列腺增生症药物的覆盖天数比例来衡量依从性。药物持有率或覆盖天数比例达到或超过0.8的患者被视为依从性良好。采用Cox比例风险模型评估与停药相关的相对风险。使用多元逻辑回归来研究与不依从或良性前列腺增生症相关手术有关的因素。
在总共2640名男性中，40%的人对任何良性前列腺增生症药物的依从性良好。使用多种药物和非那雄胺的患者中，对任何良性前列腺增生症药物依从性良好的比例显著更高（分别为62%和55%，p<0.0001）。使用多沙唑嗪、特拉唑嗪和坦索罗辛与不依从相关（分别为p = 0.008、0.04和0.03）。年轻患者和换药患者更有可能停药（p = 0.01和<0.0001），而使用多种药物的患者和有用药间隔的患者停药风险较低（分别为p = 0.01和<0.0001）。手术的预测因素包括1999年或之后的索引处方、看泌尿科医生以及对任何良性前列腺增生症药物不依从（分别为p = 0.01、<0.0001和<0.0001）。
对α受体阻滞剂的依从性低于对非那雄胺或多种药物的依从性，且不依从与手术显著相关。显然需要采取干预措施来提高对良性前列腺增生症药物的依从性。
