Perrone Enrica, Lenzi Jacopo, Avaldi Vera Maria, Castaldini Ilaria, Protonotari Adalgisa, Rucci Paola, Piccinni Carlo, Morini Mara, Fantini Maria Pia
Dipartimento di scienze biomediche e neuromotorie, Alma Mater Studiorum, Università di Bologna.
Unità operativa complessa "Programmazione e controllo", Azienda unità sanitaria locale di Bologna.
Epidemiol Prev. 2015 Mar-Apr;39(2):106-14.
to identify organisational determinants of adherence to evidence-based drug treatments after acute myocardial infarction (AMI), under the hypothesis that low adherence is associated with higher mortality and risk of reinfarction. In particular, we investigated the effect of group vs. single handed practice and multi-professional practice characteristics on patients' adherence to polytherapy after AMI.
retrospective cohort study.
residents in the Local Health Authority of Bologna (Italy) who were discharged from any Italian hospital between 2008 and 2011 with a diagnosis of AMI, and followed-up for a year.
adherence to at least three out of the four drug therapies recommended for secondary prevention of AMI (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, antiplatelet agents, statins). Patients who had at least 80% of days of follow-up covered by drug doses were considered adherent.
of the 4,828 post-AMI patients, 31.6% were adherent to polytherapy. General practice characteristics were unrelated to adherence, whereas discharge from cardiology hospital wards was significantly associated with higher patients' adherence (OR 1.97; 95%CI 1.56-2.48).
general practice organisational models are not associated with higher adherence to evidence-based medications after AMI, whereas cardiologists seem to play a key role in improving patient adherence to polytherapy. Healthcare delivery models should be designed; in them, general practitioners are responsible for the provision of patient-centred care pathways and for care co-ordination with other primary care professionals and specialists, and take an advocacy role for the patient when needed.
在低依从性与更高的死亡率和再梗死风险相关这一假设下，确定急性心肌梗死（AMI）后循证药物治疗依从性的组织决定因素。特别是，我们调查了团队执业与单人执业以及多专业执业特征对AMI后患者联合治疗依从性的影响。
回顾性队列研究。
意大利博洛尼亚地方卫生局的居民，他们于2008年至2011年间从意大利任何一家医院出院，诊断为AMI，并随访一年。
对AMI二级预防推荐的四种药物治疗中的至少三种的依从性（血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂、抗血小板药物、他汀类药物）。药物剂量覆盖至少80%随访天数的患者被视为依从。
在4828例AMI后患者中，31.6%的患者依从联合治疗。全科医疗特征与依从性无关，而从心脏病医院病房出院与患者更高的依从性显著相关（比值比1.97；95%置信区间1.56 - 2.48）。
全科医疗组织模式与AMI后循证药物的更高依从性无关，而心脏病专家似乎在提高患者对联合治疗的依从性方面发挥关键作用。应设计医疗服务提供模式；在这些模式中，全科医生负责提供以患者为中心的护理路径，并与其他初级保健专业人员和专科医生进行护理协调，并在需要时为患者发挥倡导作用。
