Sicras-Mainar A, Huerta A, Sánchez D, Navarro-Artieda R
Dirección de Planificación, Badalona Serveis Assistencials, Badalona, Barcelona, España.
Departamento de Evaluación de Medicamentos, GlaxoSmithKline, Madrid, España.
Semergen. 2018 Jan-Feb;44(1):13-22. doi: 10.1016/j.semerg.2017.03.005. Epub 2017 Apr 26.
To estimate adherence to asthma treatment with inhaled corticosteroid in clinical daily practice, and its relationship with exacerbations, as well as its use of resources and costs.
An observational, retrospective study using the electronic medical records of the Badalona Health Service provider. The study included patients≥15 years old with a confirmed diagnosed of asthma, and who initiated treatment with an inhaled corticosteroid between January 2010 and December 2011. The follow-up period was 24 months. Adherence to treatment was measured using the medication possession ratio. Two groups were established: adherent (ADH; medication possession ratio≥80%) and non-adherent (non-ADH; medication possession ratio<80%) patients. The main demographic and clinical variables, including exacerbations, were collected, along with the healthcare and non-healthcare (days of absence from work) resource use, and costs.
The study included a total of 2,303 patients, with a mean age of 48.6 years, and 64.3% females. Just over half (52.6%) of the patients had moderate persistent asthma, and 51.0% of patients adhered to treatment. In the non-ADH patients, 63.4% suffered at least one exacerbation in the follow-up period, compared with 37.4% of the adherent patients (P<.001). The non-ADH patients also consumed a higher percentage of healthcare resources in Primary Care (22.5 vs. 17.4%), secondary care (3.3 vs. 2.5%), and emergency visits (1.4 vs. 0.2%) during the follow-up period (P<.001 in all cases). No statistical significance differences were observed in the days of absence from work. Mean annual cost of non-ADH patients was 1,431€/patient, compared with 722€/patient (P<.001) of ADH patients.
Lack of adherence was associated with an increase in exacerbation rates, as well as healthcare resource consumption and costs.
评估在临床日常实践中吸入性糖皮质激素治疗哮喘的依从性，及其与病情加重、资源利用和成本的关系。
一项观察性回顾性研究，使用巴达洛纳卫生服务机构的电子病历。该研究纳入了年龄≥15岁、确诊为哮喘且在2010年1月至2011年12月期间开始吸入性糖皮质激素治疗的患者。随访期为24个月。使用药物持有率衡量治疗依从性。设立两组：依从组（ADH；药物持有率≥80%）和非依从组（非ADH；药物持有率<80%）患者。收集主要人口统计学和临床变量，包括病情加重情况，以及医疗保健和非医疗保健（缺勤天数）资源利用情况和成本。
该研究共纳入2303例患者，平均年龄48.6岁，女性占64.3%。略超过半数（52.6%）的患者患有中度持续性哮喘，51.0%的患者治疗依从。在非ADH组患者中，63.4%在随访期内至少发生一次病情加重，而依从组患者为37.4%（P<0.001）。非ADH组患者在随访期内初级保健（22.5%对17.4%）、二级保健（3.3%对2.5%）和急诊就诊（1.4%对0.2%）方面消耗的医疗资源百分比也更高（所有情况P<0.001）。在缺勤天数方面未观察到统计学显著差异。非ADH组患者的平均年成本为1431欧元/患者，而ADH组患者为722欧元/患者（P<0.001）。
治疗依从性差与病情加重率增加以及医疗资源消耗和成本增加相关。
