i3 Innovus, Eden Prairie, MN, USA.
Curr Med Res Opin. 2010 May;26(5):1023-30. doi: 10.1185/03007991003670563.
Medication adherence is an important component of effective secondary stroke prevention. The objectives of this study were to examine the impact of persistence with two prescription antiplatelet therapies on the outcome of recurrent hospitalized stroke, and to identify the predictors of nonpersistence with these antiplatelet therapies.
Administrative claims from a large, geographically diverse US health plan were used to evaluate acetylsalicylic acid / extended-release dipyridamole (ASA/ERDP) treated and clopidogrel treated patients from November 1, 2002 - December 31, 2005 who had an ischemic stroke requiring hospitalization. Nonpersistence was defined as failure to refill index medication within 30 days from the run-out date of the prior prescription. A Cox proportional hazards model was used to identify key factors associated with time to nonpersistence.
Patient demographic variables, clinical characteristics, comorbidities hypothesized to affect the risk of current stroke, stroke outcomes, treatment patterns, and compliance were assessed.
A total of 1413 patients hospitalized for ischemic stroke were identified. Mean age was 63.4 years and 44.2% were female. The proportion of patients persistent per person-year was 45.1%. Persistence with medication was significantly associated with a longer time to recurrent hospitalized stroke (HR 0.275; 95% CI 0.134-0.564; p < 0.0004). A medication copayment of >$40 (relative to a copayment of < or =$20) was the only significant factor predicting time to nonpersistence (HR 1.320; 95% CI 1.091-1.596; p < 0.0042).
Persistence with antiplatelet medication within a cohort of hospitalized ischemic stroke patients was associated with a 72.5% lower likelihood of recurrent hospitalized stroke. Higher medication copayment was found to negatively impact patient persistence with antiplatelet therapy. The findings of this study must be considered within the limitations of database analysis, as claims data are collected for the purpose of payment and not research.
药物依从性是有效二级卒中预防的重要组成部分。本研究的目的是检验两种处方抗血小板治疗的持续应用对复发性住院卒中结局的影响，并确定这些抗血小板治疗不依从的预测因素。
利用来自一家大型、地理分布广泛的美国健康计划的行政索赔数据，评估 2002 年 11 月 1 日至 2005 年 12 月 31 日期间因缺血性卒中住院且接受乙酰水杨酸/缓释双嘧达莫（ASA/ERDP）治疗和氯吡格雷治疗的患者。不依从定义为在之前处方用药用尽日期后 30 天内未能再次配药。采用 Cox 比例风险模型确定与不依从时间相关的关键因素。
评估患者人口统计学变量、临床特征、假设影响当前卒中风险的合并症、卒中结局、治疗模式和依从性。
共确定 1413 例因缺血性卒中住院的患者。平均年龄为 63.4 岁，44.2%为女性。每人每年的持续用药比例为 45.1%。药物依从性与复发性住院卒中的时间延长显著相关（HR 0.275；95%CI 0.134-0.564；p<0.0004）。药物共付额>40 美元（与<或=20 美元相比）是唯一显著预测不依从时间的因素（HR 1.320；95%CI 1.091-1.596；p<0.0042）。
在住院缺血性卒中患者队列中，抗血小板药物的依从性与复发性住院卒中的可能性降低 72.5%相关。较高的药物共付额被发现会对患者抗血小板治疗的依从性产生负面影响。本研究结果必须在数据库分析的局限性内考虑，因为索赔数据是为支付而不是为研究收集的。
