定期且连续看诊的全科医生与心血管疾病风险患者使用他汀类药物的相关性。
Regularity and Continuity of GP Contacts and Use of Statins Amongst People at Risk of Cardiovascular Events.
机构信息
Health Systems and Data Analytics, School of Public Health, Curtin University, Perth, Australia.
, Perth, Australia.
出版信息
J Gen Intern Med. 2021 Jun;36(6):1656-1665. doi: 10.1007/s11606-021-06638-3. Epub 2021 Mar 2.
BACKGROUND
Regularity and continuity of general practitioner (GP) contacts are associated with reduced hospitalisation. Opportunities for improved medication management are cited as a potential cause.
OBJECTIVE
Determine associations between continuity and regularity of primary care and statin use amongst individuals at risk of cardiovascular disease (CVD) outcomes.
DESIGN
Observational cohort study using self-report and administrative data from 267,153 participants of the Sax Institute's 45 and Up Study conducted in New South Wales, Australia. from 2006 to 2009. Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data, from Services Australia, were linked to survey, hospital and death data by the NSW Centre for Health Record Linkage.
PARTICIPANTS
The 45 and Up Study participants at risk of CVD outcomes based on self-report and administrative data, divided into existing users and potential users based on dispensing records through the exposure period.
MAIN MEASURES
The Continuity of Care index (COC), measuring whether patients see the same GP, and an index assessing whether GP visits are on a regular basis, measured from July 2011 to June 2012. Amongst potential users, statin initiation from July 2012 to June 2013 was assessed using logistic regression; amongst existing users, adherence was assessed from July 2012 to June 2015 using Cox regression (non-adherence being 30 days without statins).
KEY RESULTS
Amongst 29,420 potential users, the most regular quintile had 1.22 times the odds of initiating statin (95%CI 1.11-1.34), while the high continuity group had an odds ratio of 1.12 (95%CI 1.02-1.24). Amongst 30,408 existing users, the most regular quintile had 0.82 the hazard of non-adherence (95%CI 0.78-0.87); the high continuity group had a hazard ratio of 0.89 (95%CI 0.84-0.94).
CONCLUSIONS
Regularity and continuity of care impact on medication management. It is possible that this mediates impacts on hospitalisation. Where there is a risk of unobserved confounding, potential causal pathways should be investigated.
背景
全科医生（GP）接触的规律性和连续性与住院率降低有关。有研究指出，改善药物管理的机会是导致这种情况的潜在原因之一。
目的
确定心血管疾病（CVD）风险个体的初级保健连续性和规律性与他汀类药物使用之间的关联。
设计
利用澳大利亚新南威尔士州 45 岁及以上人群研究的自我报告和行政数据进行的观察性队列研究，该研究于 2006 年至 2009 年期间进行。医疗保险福利计划（MBS）和药品福利计划（PBS）数据由澳大利亚服务局提供，通过新南威尔士州健康记录链接中心与调查、医院和死亡数据相关联。
参与者
根据自我报告和行政数据，45 岁及以上人群研究中存在 CVD 风险的个体，根据暴露期内配药记录分为现有使用者和潜在使用者。
主要措施
连续性护理指数（COC），用于衡量患者是否看同一位全科医生，以及评估全科医生就诊是否有规律的指数，均于 2011 年 7 月至 2012 年 6 月进行测量。在潜在使用者中，使用逻辑回归评估 2012 年 7 月至 2013 年 6 月期间他汀类药物的起始使用情况；在现有使用者中，使用 Cox 回归（不遵医嘱定义为 30 天未使用他汀类药物）评估 2012 年 7 月至 2015 年 6 月期间的遵医嘱情况。
主要结果
在 29420 名潜在使用者中，最有规律的五分位组起始使用他汀类药物的可能性是最不规律五分位组的 1.22 倍（95%CI 1.11-1.34），而高连续性组的比值比为 1.12（95%CI 1.02-1.24）。在 30408 名现有使用者中，最有规律的五分位组不遵医嘱的风险比为 0.82（95%CI 0.78-0.87）；高连续性组的风险比为 0.89（95%CI 0.84-0.94）。
结论
护理的规律性和连续性会影响药物管理。这可能会影响住院率。在存在未观察到的混杂因素的情况下，应调查潜在的因果途径。
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