Juarez Deborah Taira, Williams Andrew E, Chen Chuhe, Daida Yihe Goh, Tanaka Sara K, Trinacty Connie Mah, Vogt Thomas M
University of Hawaii at Hilo, Daniel K. Inouye College of Pharmacy, 677 Ala Moana Blvd, Ste 1025, Honolulu, HI 96813. Email:
Am J Manag Care. 2015 Mar 1;21(3):e197-205.
To examine the relationship between patient characteristics and medication adherence trajectories for patients with congestive heart failure (CHF).
Historical prospective study.
We conducted a secondary analysis of data assembled for the Practice Variation and Care Outcomes (PRAVCO) study, which examined patterns of cardiovascular care. We used group based trajectory modeling to define medication adherence trajectories, and then modeled factors associated with belonging to a trajectory group during the 6year period from 2005 to 2010 (n = 10,986). We focused on the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) for secondary prevention of CHF.
Four trajectory groups were optimal in characterizing adherence level patterns: 1) low adherence group, with an initial average adherence rate of 62% that dropped to between 40% and 50%; 2) increasing adherence group, with an initial average adherence rate of 55% that increased to 90%; 3) decreasing adherence group, with an initial average adherence rate above 90% that decreased to 60%; 4) high adherence group, with an average adherence rate consistently above 90%. Age, region, education, smoking, and race were all significantly associated with the likelihood of belonging to a particular trajectory. Nonwhites were less likely to be in the high adherence group, and smoking was more common in the low adherence group (22%) than in the high group (10%); increasing body mass index and Charlson Comorbidity Index (CCI) scores were also associated with being in the low adherence group.
Population characteristics associated with sustained low adherence might be used to target interventions and improve vulnerable patients' prospects of heart health.
探讨充血性心力衰竭（CHF）患者的特征与药物依从性轨迹之间的关系。
历史性前瞻性研究。
我们对为实践差异与护理结果（PRAVCO）研究收集的数据进行了二次分析，该研究考察了心血管护理模式。我们使用基于组的轨迹模型来定义药物依从性轨迹，然后对2005年至2010年6年期间（n = 10986）属于某个轨迹组的相关因素进行建模。我们重点关注使用血管紧张素转换酶（ACE）抑制剂或血管紧张素II受体阻滞剂（ARB）进行CHF二级预防的情况。
四个轨迹组最能表征依从性水平模式：1）低依从性组，初始平均依从率为62%，随后降至40%至50%之间；2）依从性增加组，初始平均依从率为55%，随后增至90%；3）依从性降低组，初始平均依从率高于90%，随后降至60%；4）高依从性组，平均依从率始终高于90%。年龄、地区、教育程度、吸烟和种族均与属于特定轨迹的可能性显著相关。非白人在高依从性组中的可能性较小，吸烟在低依从性组（22%）中比在高依从性组（10%）中更常见；体重指数和查尔森合并症指数（CCI）得分增加也与低依从性组相关。
与持续低依从性相关的人群特征可用于确定干预目标，改善脆弱患者的心脏健康前景。
