初级保健提供者就诊频率与基于证据的他汀类药物处方和他汀类药物依从性之间的关联：来自退伍军人事务系统的研究结果。

Association between frequency of primary care provider visits and evidence-based statin prescribing and statin adherence: Findings from the Veterans Affairs system.

机构信息

Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas; and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX.

出版信息

Am Heart J. 2020 Mar;221:9-18. doi: 10.1016/j.ahj.2019.11.019. Epub 2019 Dec 7.

DOI:10.1016/j.ahj.2019.11.019

PMID:31896038

Abstract

BACKGROUND

Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed if the frequency of visits with primary care providers (PCPs) is associated with higher use of evidence-based statin prescriptions and adherence among patients with ASCVD.

METHODS

We identified patients with ASCVD aged ≥18 years receiving care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into frequent PCP visitors (annual PCP visits ≥ median number of PCP visits for the entire cohort) and infrequent PCP visitors (annual PCP visits < median number of patient visits). We assessed any- and high-intensity statin prescription as well as statin adherence which was defined by proportion of days covered (PDC).

RESULTS

We included 1,249,061 patients with ASCVD (mean age was 71.9 years; 98.0% male). Median number of annual PCP visits was 3. Approximately 80.1% patients were on statins with 23.8% on high-intensity statins. Mean PDC was 0.715 ± 0.336 with 58.3% patients with PDC ≥0.8. Frequent PCP visitors had higher frequency of statin use (82.2% vs 77.4%), high-intensity statin use (26.4% vs 20.3%), and statin adherence (mean PDC 0.73 vs 0.68; P < .01) compared to infrequent PCP visitors. After adjusting for covariates, frequent PCP visits was associated with greater odds of being on any statin, high intensity statin, and higher statin adherence.

CONCLUSION

Frequent visits with PCPs is associated with a higher likelihood of any statin use, high intensity statin use, and statin adherence. Further research endeavors are needed to understand the reasons behind these associations.

摘要

背景

在患有动脉粥样硬化性心血管疾病（ASCVD）的患者中，他汀类药物的使用仍然不理想。我们评估了初级保健提供者（PCP）就诊频率是否与 ASCVD 患者更频繁地使用基于证据的他汀类药物处方和更高的药物依从性有关。

方法

我们在 2013 年 10 月 1 日至 2014 年 9 月 30 日期间，在整个退伍军人事务医疗保健系统的 130 个设施和相关的社区门诊中，确定了年龄≥18 岁且正在接受治疗的 ASCVD 患者。患者分为高频 PCP 就诊者（每年 PCP 就诊次数≥整个队列中 PCP 就诊次数的中位数）和低频 PCP 就诊者（每年 PCP 就诊次数<患者就诊次数的中位数）。我们评估了任何强度和高强度他汀类药物处方以及他汀类药物的依从性，这是通过比例的天数来定义的（PDC）。

结果

我们纳入了 1249061 例 ASCVD 患者（平均年龄为 71.9 岁；98.0%为男性）。每年 PCP 就诊次数的中位数为 3 次。大约 80.1%的患者正在服用他汀类药物，其中 23.8%服用高强度他汀类药物。平均 PDC 为 0.715±0.336，其中 58.3%的患者 PDC≥0.8。高频 PCP 就诊者的他汀类药物使用率（82.2% vs 77.4%）、高强度他汀类药物使用率（26.4% vs 20.3%）和他汀类药物依从性（平均 PDC 0.73 vs 0.68；P<.01）均高于低频 PCP 就诊者。在校正了混杂因素后，高频 PCP 就诊与服用任何他汀类药物、高强度他汀类药物和更高的他汀类药物依从性的可能性更大有关。