Deptartment of Geriatrics, Catholic University of Rome, Rome, Italy.
Aging Research Center, Karolinska Institute and Stockholm University, Stockholm, Sweden.
Geriatr Gerontol Int. 2017 Dec;17(12):2500-2506. doi: 10.1111/ggi.13115. Epub 2017 Jun 28.
The aim of the present study was to assess the occurrence and determinants of poor adherence to pharmacological treatment in a cohort of primary care patients with chronic obstructive pulmonary disease (COPD), paying special attention to the role of age, comorbidity and polypharmacy.
We identified a cohort of COPD patients using the primary care Italian Health Search - IMS Longitudinal Patient Database. We assessed 1-year adherence to COPD maintenance pharmacotherapy (encompassing inhaled corticosteroids, long-acting beta agonists and long-acting anticholinergics). Poor adherence was defined as <80% of proportion of days covered by pharmacological treatment over a 1-year period.
Of 22 505 patients (mean age 67.3 ± 13.2; 41.3% women) entering the study, 17 486 (77.7%) were poorly adherent. According to multivariate analysis, poor adherence is less likely in older adults (OR 0.51, 95% CI 0.40-0.66), in non-smokers (OR 0.77, 95% CI 0.69-0.86) and in those with a history of alcohol abuse (OR 0.74, 95% CI 0.58-0.94). Higher comorbidity (OR 1.43, 95% CI 1.13-1.80) was positively associated with poor adherence. Polypharmacy was associated with poor adherence only in patients aged ≥65 years (OR 1.34, 95% CI 1.13-1.59). Finally, COPD severity was associated with a reduced likelihood of poor adherence (OR 0.20, 95% CI 0.07-0.61 for stage IV).
The present findings show that poor medication adherence is common in patients with COPD receiving long-term treatment. The interaction between age and polypharmacy, and the role of comorbidity suggest a pivotal role of biological age as a steering determinant of poor adherence. Geriatr Gerontol Int 2017; 17: 2500-2506.
本研究旨在评估初级保健慢性阻塞性肺疾病（COPD）患者队列中药物治疗依从性不良的发生情况及其决定因素，特别关注年龄、合并症和多种药物治疗的作用。
我们使用初级保健意大利健康搜索 - IMS 纵向患者数据库确定了 COPD 患者队列。我们评估了 1 年 COPD 维持药物治疗（包括吸入皮质激素、长效β激动剂和长效抗胆碱能药物）的依从性。药物治疗依从性差定义为 1 年内药物治疗覆盖天数比例<80%。
在纳入研究的 22505 名患者（平均年龄 67.3±13.2 岁，41.3%为女性）中，17486 名（77.7%）患者药物治疗依从性差。根据多变量分析，年龄较大（OR 0.51，95%CI 0.40-0.66）、不吸烟（OR 0.77，95%CI 0.69-0.86）和有酗酒史（OR 0.74，95%CI 0.58-0.94）的患者不太可能药物治疗依从性差。较高的合并症（OR 1.43，95%CI 1.13-1.80）与药物治疗依从性差呈正相关。只有年龄≥65 岁的患者（OR 1.34，95%CI 1.13-1.59）与药物治疗依从性差相关。最后，COPD 严重程度与药物治疗依从性降低相关（OR 0.20，95%CI 0.07-0.61，IV 期）。
本研究结果表明，接受长期治疗的 COPD 患者药物治疗依从性差较为常见。年龄和多种药物治疗之间的相互作用以及合并症的作用提示，生物年龄是药物治疗依从性不良的重要决定因素。
