CMAJ. 2013 Nov 19;185(17):E784-90. doi: 10.1503/cmaj.122010. Epub 2013 Sep 30.
The extent to which common life transitions influence medication adherence among patients remains unknown. We examined whether retirement is associated with a change in adherence to medication in patients with hypertension or type 2 diabetes.
Participants in the Finnish Public Sector study were linked to national registers. We included data for the years 1994-2011. We identified and followed 3468 adult patients with hypertension and 412 adult patients with type 2 diabetes for medication adherence for the 3 years before their retirement and the 4 years after their retirement (mean follow-up 6.8 yr). Our primary outcome was proportion of patients with poor adherence to medication, which we defined as less than 40% of days covered by treatment. We determined these proportions before and after retirement using data from filled prescriptions.
The preretirement prevalence of poor adherence to medication was 6% in men and women with hypertension, 2% in men with diabetes and 4% in women with diabetes. Among men, retirement was associated with an increased risk of poor adherence to both antihypertensive agents (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.03-1.68) and antidiabetic drugs (OR 2.40, 95% CI 1.37-4.20). Among women, an increased risk of poor adherence was seen only for antihypertensive agents (OR 1.25, 95% CI 1.07-1.46). Similar results were apparent for alternative definitions of poor adherence. Our results did not differ across strata of age, socioeconomic status or comorbidity.
We found a decline in adherence to medication after retirement among men and women with hypertension and men with type 2 diabetes. If these findings can be confirmed, we need randomized controlled trials to determine whether interventions to reduce poor adherence after retirement could improve clinical outcomes of treatments for hypertension and diabetes.
共同的生活转变对患者用药依从性的影响程度尚不清楚。我们研究了退休是否与高血压或 2 型糖尿病患者的药物依从性变化相关。
芬兰公共部门研究的参与者与国家登记处相关联。我们纳入了 1994-2011 年的数据。我们确定并随访了 3468 名成年高血压患者和 412 名成年 2 型糖尿病患者，以评估他们在退休前 3 年和退休后 4 年的药物依从性（平均随访 6.8 年）。我们的主要结局是药物依从性差的患者比例，我们将其定义为治疗覆盖天数少于 40%。我们使用填写处方的数据在退休前后确定这些比例。
高血压男性和女性患者中，退休前药物依从性差的患病率为 6%，男性糖尿病患者为 2%，女性糖尿病患者为 4%。对于男性，退休与抗高血压药物（比值比 [OR] 1.32，95%置信区间 [CI] 1.03-1.68）和抗糖尿病药物（OR 2.40，95% CI 1.37-4.20）的药物依从性差的风险增加相关。对于女性，仅发现抗高血压药物的药物依从性差的风险增加（OR 1.25，95% CI 1.07-1.46）。对于其他药物依从性差的定义，也出现了类似的结果。我们的结果在年龄、社会经济地位或合并症的不同分层中没有差异。
我们发现高血压男性和女性以及 2 型糖尿病男性患者在退休后药物依从性下降。如果这些发现可以得到证实，我们需要进行随机对照试验，以确定退休后减少药物依从性差的干预措施是否可以改善高血压和糖尿病治疗的临床效果。
