University of Miami/Miller School of Medicine, Miami, FL, USA.
J Vasc Surg. 2010 Apr;51(4 Suppl):4S-8S. doi: 10.1016/j.jvs.2010.01.035.
Vascular disease is the most prevalent condition in patients aged >60 years, leading to increasing complications associated with their comorbid conditions. Poor medical compliance could be one reason why the rate of complications may be higher in this patient population, particularly the uninsured. This study was conducted to better assess rates of medication compliance in vascular surgical patients.
Consecutive patients seen in vascular clinics at a busy tertiary academic center were prospectively studied. Physicians and physician assistants used a standardized questionnaire to collect patient data and evaluated patients for coexisting medical conditions and medication use. Optimal medical therapy was defined according to the 2006 American Heart Association (AHA)/American College of Cardiology (ACC) "Guidelines for Secondary Prevention for Atherosclerotic Vascular Disease." Data were analyzed using multivariate regression.
During the 4-month study period, 180 consecutive patients (47% men) were seen in vascular surgery clinics. Most patients (79%) were nonsmokers and only 21% admitted to smoking. Comorbid conditions surveyed included hypertension in 141, diabetes mellitus in 56, coronary artery disease in 24, hypercholesterolemia in 89, and chronic renal failure in 13; of these, 61% were insured and 39% had no insurance. Overall, only 31% of all patients were receiving adequate medical therapy for their comorbid conditions, and about 66% were receiving suboptimal medical treatment for their vascular disease. Uninsured patients were less likely (19%) than insured patients (39%) to receive optimal medical therapy (P = .012). Lack of insurance was a predictor of suboptimal medical therapy for hypertension (odds ratio [OR], 3.13; 95% confidence interval [CI], 1.20-8.16; P = .016), hypercholesterolemia (OR, 5.1; 95% CI, 1.87-13.88; P = .001), peripheral arterial disease (OR, 13.32; 95% CI, 2.84-62.54, P < .001), and any disease overall (OR, 2.43; 95% CI, 1.21-4.88, P = .012). Overall, men and women were equally likely (68%) to receive suboptimal medical therapy; however, women were significantly more likely to be undertreated for coronary artery disease (OR, 0.022; 95% CI, 0.0017-0.293; P < .001).
Compliance with optimal medical therapy for secondary risk factor management amongst our vascular surgery patients is low. Uninsured patients are less likely to receive optimal medical therapy than their insured counterparts. This survey provides sobering statistics regarding medical compliance in our population. This issue deserves further study and may indirectly affect outcomes in minority groups that are disproportionately represented in our uninsured patients.
血管疾病是 60 岁以上患者最常见的疾病，导致与其合并症相关的并发症不断增加。较差的医疗依从性可能是导致该患者群体并发症发生率较高的原因之一，尤其是未参保人群。本研究旨在更好地评估血管外科患者的药物治疗依从性。
连续对在繁忙的三级学术中心血管诊所就诊的患者进行前瞻性研究。医生和医师助理使用标准化问卷收集患者数据，并评估患者的合并症和药物使用情况。根据 2006 年美国心脏协会（AHA）/美国心脏病学会（ACC）“动脉粥样硬化血管疾病二级预防指南”，定义最佳药物治疗。使用多元回归分析数据。
在 4 个月的研究期间，血管外科诊所共接诊了 180 例连续患者（47%为男性）。大多数患者（79%）不吸烟，只有 21%承认吸烟。调查的合并症包括高血压 141 例、糖尿病 56 例、冠心病 24 例、高胆固醇血症 89 例和慢性肾衰竭 13 例；其中，61%有保险，39%没有保险。总体而言，只有 31%的患者接受了针对其合并症的充分药物治疗，约 66%的患者接受了血管疾病的次优药物治疗。未参保患者（19%）比参保患者（39%）接受最佳药物治疗的可能性更小（P=0.012）。缺乏保险是高血压（比值比[OR]，3.13；95%置信区间[CI]，1.20-8.16；P=0.016）、高胆固醇血症（OR，5.1；95%CI，1.87-13.88；P=0.001）、外周动脉疾病（OR，13.32；95%CI，2.84-62.54，P<0.001）和任何疾病（OR，2.43；95%CI，1.21-4.88，P=0.012）次优药物治疗的预测因素。总体而言，男性和女性接受次优药物治疗的可能性相同（68%）；然而，女性患冠心病的治疗不足的可能性明显更高（OR，0.022；95%CI，0.0017-0.293；P<0.001）。
我们血管外科患者接受二级危险因素管理的最佳药物治疗依从性较低。未参保患者接受最佳药物治疗的可能性低于参保患者。本调查提供了有关我们人群中医疗依从性的令人警醒的统计数据。这个问题值得进一步研究，并可能间接地影响到在我们未参保患者中比例过高的少数族裔群体的结果。
