Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy.
Direzione Sanitaria-Centro Cardiologico Monzino (I.R.C.C.S.), 20138 Milan, Italy.
Int J Environ Res Public Health. 2022 May 7;19(9):5692. doi: 10.3390/ijerph19095692.
Poor medication adherence compromises treatment efficacy and adversely affects patients' clinical outcomes. This study aims to assess (1) multiple medication adherence to the most common drug classes chronically prescribed to older people, (2) the factors associated, and (3) the clinical outcomes. This retrospective cohort study included 122,655 community-dwelling patients aged 65-94 years old, newly exposed to chronic polypharmacy, and recorded in the Lombardy Region (northern Italy) administrative database from 2016 to 2018. Multiple medication adherence was assessed for drugs for diabetes, antithrombotics, antihypertensives, statins, and bisphosphonates, by calculating the daily polypharmacy possession ratio (DPPR). One-year mortality, nursing home, emergency department (ED), and hospital admission rates were calculated for 2019. The most prescribed drugs were antihypertensives (89.0%). The mean (std.dev) DPPR was 82.9% (15.6). Being female (OR = 0.85, 95%CI: 0.84-0.86), age ≥85 years (OR = 0.77, 95%CI: 0.76-0.79), and multimorbidity (≥4 diseases, OR = 0.88, 95%CI: 0.86-0.90) were associated with lower medication adherence. A higher DPPR was associated with clinical outcomes-in particular, improved survival (HR = 0.93 for 10/100-point increase, 95%CI: 0.92-0.94) and lower incidence in nursing home admissions (SDHR = 0.95, 95%CI: 0.93-0.97). Adherence to the most common chronic drugs co-prescribed to the older population was high. Better multiple medication adherence was associated with better clinical outcomes.
药物治疗依从性差会影响治疗效果，并对患者的临床结局产生不利影响。本研究旨在评估：（1）老年人长期服用的最常见药物类别的多重药物治疗依从性；（2）相关因素；（3）临床结局。这项回顾性队列研究纳入了 2016 年至 2018 年在意大利北部伦巴第地区行政数据库中记录的 122655 名年龄在 65-94 岁之间、新开始接受慢性多种药物治疗的社区居民。通过计算每日复方药物持有率（DPPR）来评估糖尿病、抗血栓形成药、抗高血压药、他汀类药物和双膦酸盐类药物的多重药物治疗依从性。计算了 2019 年的一年死亡率、疗养院入住率、急诊部（ED）和住院入院率。最常开的药物是抗高血压药（89.0%）。DPPR 的平均值（标准差）为 82.9%（15.6）。女性（比值比 [OR] = 0.85，95%置信区间 [CI]：0.84-0.86）、年龄≥85 岁（OR = 0.77，95%CI：0.76-0.79）和合并症（≥4 种疾病，OR = 0.88，95%CI：0.86-0.90）与较低的药物治疗依从性相关。更高的 DPPR 与临床结局相关，特别是提高了生存率（每增加 100 分，风险比 [HR] = 0.93，95%CI：0.92-0.94）和降低了疗养院入院率（标准死亡风险比 [SDHR] = 0.95，95%CI：0.93-0.97）。为老年人群共同开具的最常见慢性药物的依从性较高。更好的多重药物治疗依从性与更好的临床结局相关。
