School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
Clin Ther. 2011 May;33(5):617-28. doi: 10.1016/j.clinthera.2011.04.019.
Dyslipidemia is a significant health problem, and persistent use of lipid-lowering agents among dyslipidemic patients is clinically important. However, few studies have evaluated the profiles of medication discontinuation among ethnic Chinese patients.
The objective of this study was to evaluate the level of medication adherence among Chinese patients who were prescribed a lipid-lowering drug and to investigate factors that could help physicians identify patients at risk for discontinuing their medication.
All patients who attended any primary care clinic in 1 territory of Hong Kong and were prescribed at least 1 lipid-lowering agent from January 2004 to June 2007 were included. The incidences of drug discontinuation within 180 days after drug prescriptions were measured, and the factors associated with discontinuation using binary logistic regression analyzes were evaluated.
Of the 12,875 eligible patients, the majority were prescribed fibrates (54.4%) and statins (45.1%). Among the patients, 17.0% discontinued their medication. Older patients (adjusted odds ratio [aOR] = 0.72-0.79 for patients >50 years), male subjects (aOR = 0.87; 95% CI, 0.78-0.97; P = 0.009), fee payers (aOR = 0.88; 95% CI, 0.78-0.99; P = 0.029), attendees in family medicine specialist clinics (aOR = 0.82; 95% CI, 0.70-0.96; P = 0.013), residents in rural districts (aOR = 0.52; 95% CI, 0.44-0.60; P < 0.001), follow-up visitors (aOR = 0.60; 95% CI, 0.54-0.66; P < 0.001), patients with comorbidities (aOR = 0.39; 95% CI, 0.35-0.44; P < 0.001 for 1 comorbidity and aOR = 0.28; 95% CI, 0.25-0.33; P < 0.001 for at least 2 comorbidities), and persons who use fibrates (aOR = 0.56; 95% CI, 0.49-0.64; P < 0.001) were significantly less likely to discontinue their medication.
The findings of these associated factors were new for ethnic Chinese patients. These findings could help physicians identify patients who had been prescribed a lipid-lowering agent who were at higher risk of discontinuing their medication. Their medication-taking behavior should be monitored more closely, and future studies should evaluate the reasons of drug discontinuation.
血脂异常是一个严重的健康问题，临床中血脂异常患者持续使用降脂药物非常重要。然而，很少有研究评估过华裔患者药物停药的情况。
本研究旨在评估接受降脂药物治疗的华裔患者的药物依从性水平，并探讨有助于医生识别有停药风险患者的因素。
纳入 2004 年 1 月至 2007 年 6 月期间在香港 1 个地区的任何初级保健诊所就诊并至少开了 1 种降脂药物的所有患者。测量药物处方后 180 天内停药的发生率，并使用二元逻辑回归分析评估与停药相关的因素。
在 12875 名合格患者中，大多数患者被开了贝特类药物（54.4%）和他汀类药物（45.1%）。在这些患者中，有 17.0%的人停止了服药。年龄较大的患者（>50 岁患者的调整后优势比[OR]为 0.72-0.79）、男性（OR=0.87；95%CI，0.78-0.97；P=0.009）、自费患者（OR=0.88；95%CI，0.78-0.99；P=0.029）、家庭医学专科诊所就诊者（OR=0.82；95%CI，0.70-0.96；P=0.013）、居住在农村地区的患者（OR=0.52；95%CI，0.44-0.60；P<0.001）、随访就诊者（OR=0.60；95%CI，0.54-0.66；P<0.001）、有合并症的患者（OR=0.39；95%CI，0.35-0.44；P<0.001 有 1 种合并症，OR=0.28；95%CI，0.25-0.33；P<0.001 有 2 种或以上合并症）和使用贝特类药物的患者（OR=0.56；95%CI，0.49-0.64；P<0.001）停药的可能性显著降低。
这些相关因素的发现对于华裔患者来说是新的。这些发现可以帮助医生识别出那些被开了降脂药物且停药风险较高的患者。应更密切地监测他们的服药行为，未来的研究应评估停药的原因。
