Benner Joshua S, Chapman Richard H, Petrilla Allison A, Tang Simon S K, Rosenberg Noah, Schwartz J Sanford
Engelberg Center for Health Care Reform, The Brookings Institution, Washington, DC.
Am J Health Syst Pharm. 2009 Aug 15;66(16):1471-7. doi: 10.2146/ajhp080238.
The association between prescription burden and medication adherence in patients initiating antihypertensive and lipid-lowering therapy was studied.
Patients enrolled in managed care organizations who initiated antihypertensive therapy coincident with lipid-lowering therapy (no more than 90 days apart) between January 1, 1997, and April 30, 2000, were eligible for inclusion. Analysis was limited to new users of antihypertensive and lipid-lowering therapy. The proportion of days covered (PDC) by antihypertensive and lipid-lowering therapy was calculated for the first year after therapy initiation; patients with a PDC of > or =80% for both drug classes were considered adherent. Prescription burden was defined as the number of prescription medications taken in the year prior to starting antihypertensive and lipid-lowering therapy. Demographic, clinical, and health-service-use variables associated with both prescription burden and medication adherence were measured using medical and pharmacy claims data from the year before initiation of antihypertensive and lipid-lowering therapy.
Among 5759 patients, the mean +/- S.D. prescription burden was 3.6 +/- 3.7 (median, 3) medications, and the mean +/- S.D. PDC with antihypertensive and lipid-lowering therapy was 53.9% +/- 31.9% (median, 58.5%). Among patients with 0, 1, and 2 prior medications, 41%, 35%, and 30% of patients were adherent, respectively, to antihypertensive and lipid-lowering therapy. Among patients with 10 or more prior medications, 20% were adherent.
Among patients in a managed care database taking antihypertensive and lipid-lowering medications, adherence to those regimens became less likely as the number of prescription medications increased. The reduction in adherence with additional prescription medications was greatest in patients with the fewest preexisting prescriptions.
研究开始接受抗高血压和降脂治疗的患者中处方负担与药物依从性之间的关联。
纳入1997年1月1日至2000年4月30日期间在管理式医疗组织中同时开始抗高血压治疗和降脂治疗（间隔不超过90天）的患者。分析仅限于抗高血压和降脂治疗的新使用者。计算治疗开始后第一年抗高血压和降脂治疗的覆盖天数比例（PDC）；两种药物类别PDC均≥80%的患者被视为依从。处方负担定义为开始抗高血压和降脂治疗前一年服用的处方药数量。使用抗高血压和降脂治疗开始前一年的医疗和药房报销数据测量与处方负担和药物依从性相关的人口统计学、临床和卫生服务使用变量。
在5759例患者中，平均±标准差处方负担为3.6±3.7（中位数为3）种药物，抗高血压和降脂治疗的平均±标准差PDC为53.9%±31.9%（中位数为58.5%）。在之前服用0、1和2种药物的患者中，分别有41%、35%和30%的患者对抗高血压和降脂治疗依从。在之前服用10种或更多药物的患者中，20%的患者依从。
在管理式医疗数据库中服用抗高血压和降脂药物的患者中，随着处方药数量的增加，坚持这些治疗方案的可能性降低。在原有处方最少的患者中，额外处方药导致的依从性下降最大。
