Martin-Latry Karin, Cazaux Julie, Lafitte Marianne, Couffinhal Thierry
Univ. de Bordeaux, Adaptation cardiovasculaire à l'ischémie, U1034, France; CHU de Bordeaux, Centre d'exploration, de prévention et de traitement de l'athérosclérose, France; INSERM U1034, Adaptation cardiovasculaire à l'ischémie, Pessac, France.
Pharmacoepidemiol Drug Saf. 2014 Oct;23(10):1088-92. doi: 10.1002/pds.3608. Epub 2014 Mar 19.
The aim of this study was to determine whether dosing schedule requirements impair overall cardiovascular drug adherence.
A cohort study was performed with hospitalized patients at high risk of cardiovascular disease between April and September 2011. Patients were asked whether the prescribed time for taking their statin and antiplatelet drugs created any inconvenience in their daily routine and, if so, were asked to describe the reasons. Patient adherence to treatment was assessed using the Morisky Medication Adherence Scale (MMAS-8). A cohort of physicians was separately studied between June and September 2011. Physicians were interviewed to determine their dosing schedule preference when prescribing statin and anti-platelet drugs, and the rationale for choosing a specific dosing schedule.
In the study, 103 patients and 59 physicians were included. Statins were most frequently prescribed in the evening (90%). Thienopyridines were prescribed both at lunch time (41%) and in the morning (35%). Aspirin was most frequently (65.3%) prescribed at lunch time. In total, 24.3% of patients reported being inconvenienced by their drug dosing schedule, and these subjects were less adherent to their drug regimen than those who did not report inconvenience (46.2% versus 16.7%, p = 0.014). Our results also demonstrate that there is no pharmacologic rationale for prescribing a particular drug dosing schedule for statin or anti-platelet drugs.
Physicians should assess patient convenience, when prescribing medication, to optimize treatment adherence.
本研究旨在确定给药时间表要求是否会影响心血管药物的总体依从性。
对2011年4月至9月期间住院的心血管疾病高危患者进行了一项队列研究。询问患者服用他汀类药物和抗血小板药物的规定时间是否给他们的日常生活带来不便，如果是，则要求他们说明原因。使用Morisky药物依从性量表（MMAS-8）评估患者的治疗依从性。2011年6月至9月期间对一组医生进行了单独研究。对医生进行访谈，以确定他们在开具他汀类药物和抗血小板药物时对给药时间表的偏好，以及选择特定给药时间表的理由。
本研究纳入了103名患者和59名医生。他汀类药物最常在晚上开具（90%）。噻吩吡啶类药物在午餐时间（41%）和早上（35%）开具。阿司匹林最常在午餐时间开具（65.3%）。总共有24.3%的患者报告其给药时间表带来不便，这些患者对药物治疗方案的依从性低于未报告不便的患者（46.2%对16.7%，p = 0.014）。我们的结果还表明，对于他汀类药物或抗血小板药物，没有药理学依据来规定特定的给药时间表。
医生在开药时应评估患者的便利性，以优化治疗依从性。
