Department of General Internal Medicine, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland. Email:
Am J Manag Care. 2022 May 1;28(5):e157-e162. doi: 10.37765/ajmc.2022.89146.
To change blood pressure treatment, clinicians can modify medication count or dose. However, existing studies have measured count modification, which may miss clinically important dose change in the absence of count change. This research demonstrates how dose modification captures more information about management than medication count alone.
Retrospective cohort study.
We included patients 65 years and older with established primary care at the Veterans Health Administration (July 2011-June 2013). We captured medication count and standardized dose change over 90 to 120 days using a validated pharmacy fill algorithm. We determined frequency of dose change without count change (and vice versa), no change in either, change in same direction ("concordant"), and change in opposite direction ("discordant"). We compared change according to systolic blood pressure (SBP) and compared concordance using a minimum threshold definition of dose change of at least 50% (instead of any change) of baseline dose modification.
Among 440,801 patients, 64.2% had dose change; 22.0%, count change; 35.6%, no change in either; 42.4%, dose change without count modification; and 0.2%, count change without dose modification. Discordance occurred in 2.1% of observations. Using the minimum threshold definition of change, 68.7% had no change in either dose or count. Treatment was more frequently changed at SBP greater than 140 mm Hg.
Measuring change in antihypertensive treatment using medication count frequently missed an isolated dose change in treatment modification and less often misclassified regimen modifications where there was no modification in total dose. In future research, measuring dose modification using our new algorithm would capture change in hypertension treatment intensity more precisely than current methods.
改变血压治疗，临床医生可以修改药物计数或剂量。然而，现有的研究已经测量了计数的修改，这可能会错过没有计数变化的临床重要剂量变化。本研究表明，剂量修改比单独使用药物计数能更全面地捕捉管理信息。
回顾性队列研究。
我们纳入了在退伍军人健康管理局（2011 年 7 月至 2013 年 6 月）有既定初级保健的 65 岁及以上患者。我们使用经过验证的药房填充算法，在 90 至 120 天内捕获药物计数和标准化剂量变化。我们确定了没有计数变化的剂量变化的频率（反之亦然），以及没有变化、方向相同的变化（“一致”）和方向相反的变化（“不一致”）。我们根据收缩压（SBP）比较了变化，并使用剂量变化的最小阈值定义（至少 50%的基线剂量变化）而不是任何变化来比较一致性。
在 440801 名患者中，64.2%有剂量变化；22.0%，计数变化；35.6%，两者均无变化；42.4%，剂量变化而无计数变化；0.2%，计数变化而无剂量变化。在 2.1%的观察中发生了不一致。使用变化的最小阈值定义，68.7%的患者在剂量或计数上均无变化。在 SBP 大于 140mmHg 时，治疗更频繁地改变。
使用药物计数测量降压治疗的变化，经常会错过治疗修改中孤立的剂量变化，而较少错误分类总剂量没有变化的方案修改。在未来的研究中，使用我们的新算法测量剂量变化将比目前的方法更精确地捕捉高血压治疗强度的变化。
