利用日本全国范围内基于索赔的数据库确定影响 2 型糖尿病患者用药依从性的因素。
Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan.
机构信息
Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Kanagawa, Japan.
Department of Pharmacy, The Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
出版信息
PLoS One. 2019 Oct 8;14(10):e0223431. doi: 10.1371/journal.pone.0223431. eCollection 2019.
BACKGROUND
The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan.
METHODS
This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient's possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications.
RESULTS
Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50-<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period.
CONCLUSIONS
We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50-<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.
背景
在开始使用降血糖药物治疗 2 型糖尿病（T2DM）多年后，患者的药物依从性程度尚不清楚。针对该人群的药物依从性研究大多在一年或基于问卷调查的基础上进行。本研究旨在使用日本全国性的医疗索赔数据库，确定降血糖药物起始治疗 3 年后的药物依从性状况及影响药物依从性的因素。
方法
本回顾性研究纳入了 884 例 T2DM 患者的数据，以更好地了解药物依从性、多药治疗的影响及其他因素。我们还调查了药物不依从对糖化血红蛋白水平的影响。药物覆盖度定义为开具降血糖药物的天数与观察期内的天数之比。药物覆盖度≥0.8 被认为是依从的，<0.8 则为不依从。多药治疗定义为服用≥5 种药物。
结果
在所调查的 884 例患者中，440 例在研究期间被认为是依从的。与依从性相关的显著因素包括服用药物的数量（3 种或 4 种或≥5 种）、男性、50-<60 岁、就诊次数≥17 次。药物依从性也是与观察期末糖化血红蛋白值<7.0%的患者相关的因素。
结论
我们对开始使用降血糖药物后的 3 年进行了药物依从性调查，发现 50-<60 岁、同时服用≥3 种药物和就诊次数≥17 次的患者更有可能坚持和持续使用降血糖药物，并且更有可能继续服用。高度的药物依从性对糖化血红蛋白水平有积极影响。
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