Value Institute, Christiana Care Health System, Newark, Delaware.
Hospital Medicine, The University of Alabama at Birmingham.
J Manag Care Spec Pharm. 2020 Mar;26(3):305-310. doi: 10.18553/jmcp.2020.26.3.305.
Timely initiation of medication therapy after a cardiovascular event is vital to achieve optimal patient outcomes, yet there is a lack of insight on the frequency and predictors of discharge medications that are delayed or never initiated.
To (a) describe how frequently patients do not fill newly prescribed discharge medications within 30 days after revascularization and (b) identify predictors of patients who did not fill their new medications.
A single-center, retrospective analysis was conducted of patients discharged after percutaneous coronary intervention or coronary artery bypass grafting. Discharge prescriptions were linked to pharmacy claims data to identify medications that were not filled within 30 days of discharge.
1,206 patients and their 5,253 discharge medications were included for study. More than one third of patients did not fill at least 1 discharge medication within 30 days (466/1,206, 38.6%); nearly 1 in 10 (116/1,206, 9.6%) did not fill any of their discharge prescriptions. Significant predictors of nonadherence included longer length of stay and higher number of prescribed discharge medications (both values < 0.05). The largest classes of unfilled medications included insulin, factor Xa inhibitors, and narcotic analgesics.
Noninitiation is a common issue among patients after cardiac revascularization. These patients may be at a higher risk of not filling their medications if they experience longer lengths of stay or are prescribed a higher number of medications at discharge.
This work was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod). The sponsor had no connection with Surescripts and no role in the study design, data analysis, interpretation of results, or development of this manuscript. Glasgow reports personal fees from Burroughs Group, outside the submitted work. The other authors have nothing to disclose. Preliminary results from this work were presented as a poster presentation at the 2018 AcademyHealth Annual Research Meeting; June 24-26, 2018; Seattle, WA.
心血管事件发生后及时开始药物治疗对于实现患者最佳预后至关重要，但对于出院药物延迟或从未开始使用的频率和预测因素缺乏了解。
(a)描述经皮冠状动脉介入治疗或冠状动脉旁路移植术后出院患者中，新开具的出院药物在 30 天内未服用的频率；(b)确定未服用新药物的患者的预测因素。
对经皮冠状动脉介入治疗或冠状动脉旁路移植术后出院的患者进行单中心回顾性分析。将出院处方与药房索赔数据相关联，以确定出院后 30 天内未服用的药物。
共纳入 1206 例患者及其 5253 种出院药物进行研究。超过三分之一的患者在 30 天内至少有 1 种出院药物未服用（466/1206，38.6%）；近十分之一（116/1206，9.6%）的患者未服用任何出院处方。不依从的显著预测因素包括住院时间延长和出院时开具的药物数量增加（均 P 值<0.05）。未服用的主要药物类别包括胰岛素、因子 Xa 抑制剂和麻醉性镇痛药。
心脏血运重建术后患者中药物不起始使用的情况较为常见。如果患者住院时间延长或出院时开具的药物数量增加，这些患者不服用药物的风险可能更高。
这项工作得到了美国国立卫生研究院国家普通医学科学研究所机构发展奖（IDeA）的支持，资助号为 U54-GM104941（PI：Binder-Macleod）。资助者与 Surescripts 没有任何联系，也没有参与研究设计、数据分析、结果解释或本手稿的编写。Glasgow 报告个人从 Burroughs Group 获得的酬金，与提交的工作无关。其他作者没有什么可披露的。这项工作的初步结果以海报形式在 2018 年 6 月 24 日至 26 日在西雅图举行的 2018 年美国健康学院年度研究会议上展示。
