Ana M. Palacio, MD, MPH Associate Professor, School of Medicine, Departments of Medicine and Public Health Sciences and Veterans Affairs Medical Center, University of Miami Miller, Florida. Denise C. Vidot, PhD Assistant Professor, School of Nursing and Health Studies, University of Miami, Florida. Leonardo J. Tamariz, MD, MPH Associate Professor, School of Medicine, Departments of Medicine and Public Health Sciences, and Veterans Affairs Medical Center, University of Miami Miller, Florida. Claudia Uribe, MD, MHA Research Manager, Comprehensive Health Insights, Miami, Florida. Leslie Hazel-Fernandez, PhD Researcher, Comprehensive Health Insights, Miami, Florida. Hua Li, MD, PhD Biostatistician, School of Medicine, Departments of Medicine and Public Health Sciences, and Veterans Affairs Medical Center, University of Miami Miller, Florida. Sylvia D. Garay, MD Assistant Scientist/Motivational Interviewing Coach, School of Medicine, Department of Medicine, University of Miami Miller, Florida. Olveen Carrasquillo, MD, MPH Professor, School of Medicine, Departments of Medicine and Public Health Sciences, University of Miami Miller, Florida.
J Cardiovasc Nurs. 2017 Nov/Dec;32(6):522-529. doi: 10.1097/JCN.0000000000000387.
Lack of medication adherence is associated with significant morbidity and mortality, particularly among minorities. We aim to identify predictors of nonadherence to antiplatelet medications at the time of percutaneous coronary intervention (PCI) with stent among African American and Hispanic patients.
We used data collected for a randomized clinical trial that recruited 452 minority patients from a large US health insurance organization in 2010 post-PCI to compare telephone-based motivational interviewing by trained nurses with an educational video. The primary outcome was 12-month adherence to antiplatelet medications measured by the claims-based medication possession ratio (MPR). Adequate adherence was defined as an MPR of 0.80 or higher.
More than half of the sample (age, 69.52 ± 8.8 years) was male (57%) and Hispanic (57%). Most (78%) had a median income below $30 000 and 22% completed high school or higher. Univariate analyses revealed that symptoms of depression (<.01) and not having a spouse (P = .03) were associated with inadequate adherence. In multivariate analysis, baseline self-reported adherence (1.4; 95% confidence interval [CI], 1.05-1.89), depressive symptoms (0.49; 95% CI, 0.7-0.90), comorbidity (0.89; 95% CI, 0.80-0.98), and telephone-based motivational interviewing by trained nurses (3.5; 95% CI, 1.9-2.70) were associated with adherence.
Having multiple comorbidities, depression, suboptimal adherence to medications, and low English proficiency at the time of PCI increase the risk of poor 12-month adherence to antiplatelets among minorities. Identifying these risk factors can guide PCI therapy and the use of evidence-based strategies to improve long-term adherence.
药物依从性差与重大发病率和死亡率相关，尤其是在少数族裔中。我们旨在确定在接受经皮冠状动脉介入治疗（PCI）置入支架后，非裔美国人和西班牙裔患者抗血小板药物依从性的预测因素。
我们使用了 2010 年从一家大型美国健康保险公司招募的 452 名少数族裔患者在 PCI 后进行的一项随机临床试验的数据，以比较由经过培训的护士进行的电话为基础的动机访谈与教育视频。主要结局是通过基于索赔的药物使用比例（MPR）测量的 12 个月抗血小板药物的依从性。适当的依从性定义为 MPR 达到 0.80 或更高。
该样本的一半以上（年龄为 69.52±8.8 岁）为男性（57%）和西班牙裔（57%）。大多数人（78%）的中位数收入低于 30000 美元，22%的人完成了高中或以上学历。单变量分析显示，抑郁症状（<0.01）和没有配偶（P=0.03）与依从性差相关。多变量分析显示，基线时自我报告的依从性（1.4；95%置信区间[CI]，1.05-1.89）、抑郁症状（0.49；95% CI，0.7-0.90）、合并症（0.89；95% CI，0.80-0.98）和由经过培训的护士进行的电话为基础的动机访谈（3.5；95% CI，1.9-2.70）与依从性相关。
在 PCI 时存在多种合并症、抑郁、药物依从性差和英语水平低会增加少数族裔患者 12 个月内对抗血小板药物依从性差的风险。确定这些风险因素可以指导 PCI 治疗，并使用循证策略来改善长期依从性。
