Baggarly Scott A, Kemp Robert J, Wang Xiaojun, Magoun A Dale
Department of Clinical and Administrative Sciences, University of Louisiana at Monroe College of Pharmacy, 1800 Bienville Drive, Monroe, LA 71201, USA.
Department of Clinical and Administrative Sciences, University of Louisiana at Monroe College of Pharmacy, 1800 Bienville Drive, Monroe, LA 71201, USA.
Res Social Adm Pharm. 2014 Nov-Dec;10(6):e99-e112. doi: 10.1016/j.sapharm.2014.02.002. Epub 2014 Feb 15.
Non-adherence with antihypertensive therapy is a significant problem. Prior research has generally focused upon one drug or one drug class. Current information across multiple antihypertensive drug classes is limited.
To describe the initial treatment of recipients of Louisiana Medicaid with newly-diagnosed hypertension; evaluate differences in adherence and persistence rates among multiple antihypertensive drug classes; and test the association of drug classes, race, gender, age and comorbidity with adherence and persistence to drug therapy.
In a retrospective analysis of administrative claims data, initial therapy was described by type and drug class for 4544 Medicaid recipients with newly-diagnosed hypertension. Recipients were placed into cohorts based upon drug classes (diuretics, beta-blockers, angiotensin-II receptor blockers, angiotensin converting enzyme inhibitors, and calcium channel blockers). Persistence with drug therapy and Medication Possession Ratios (MPR) were calculated for 6-month and 12-month periods following diagnosis. Drug class and demographic variables were used as predictor variables in logistic regression analyses of persistence and MPR.
Recipients in the study group were primarily female (66%) and Black (65%). Recipients initially were treated with monotherapy (33%), multiple drugs (11%), fixed combinations (8%) or no drugs (48%). After one year, 62% of recipients were not receiving drug therapy. Persistence rates by cohort ranged from 26% to 42% at 6-months following diagnosis, and 14%-28% at 12-months. The proportion of recipients by cohort with MPRs of 0.8 or above ranged from 43% to 60% at 6-months and 25%-42% at 12-months. Race, comorbidities, and initial drug therapy were significant predictors of both persistence and MPR.
Within this study group, adherence and persistence to medication therapy were less than optimal. Future efforts to improve compliance with medication therapy could be focused upon specific groups having poor adherence and/or persistence within the drug class cohorts analyzed in this study.
不坚持抗高血压治疗是一个重大问题。先前的研究通常聚焦于一种药物或一类药物。目前关于多种抗高血压药物类别的信息有限。
描述路易斯安那医疗补助计划新诊断高血压患者的初始治疗情况；评估多种抗高血压药物类别在依从性和持续性方面的差异；并测试药物类别、种族、性别、年龄和合并症与药物治疗依从性和持续性之间的关联。
在对行政索赔数据的回顾性分析中，描述了4544名新诊断高血压的医疗补助计划接受者的初始治疗类型和药物类别。根据药物类别（利尿剂、β受体阻滞剂、血管紧张素II受体阻滞剂、血管紧张素转换酶抑制剂和钙通道阻滞剂）将接受者分为不同队列。计算诊断后6个月和12个月期间的药物治疗持续性和药物持有率（MPR）。在持续性和MPR的逻辑回归分析中，将药物类别和人口统计学变量用作预测变量。
研究组中的接受者主要为女性（66%）和黑人（65%）。接受者最初接受单一疗法（33%）、多种药物治疗（11%）、固定组合治疗（8%）或未接受药物治疗（48%）。一年后，62%的接受者未接受药物治疗。各队列在诊断后6个月时的持续性率为26%至42%，12个月时为14%至28%。各队列中MPR为0.8或以上的接受者比例在6个月时为43%至60%，12个月时为25%至42%。种族、合并症和初始药物治疗是持续性和MPR的重要预测因素。
在该研究组中，药物治疗的依从性和持续性不理想。未来改善药物治疗依从性的努力可集中于本研究分析的药物类别队列中依从性和/或持续性较差的特定群体。
