高血压横断面研究中测量的患者用药组织策略与依从性
Patient Pill Organization Strategies and Adherence Measured in a Cross-Sectional Study of Hypertension.
作者信息
Genelin Matthew P, Helmkamp Laura J, Steiner John F, Maertens Julie A, Hanratty Rebecca, Vupputuri Suma, Havranek Edward P, Dickinson L Miriam, Blair Irene V, Daugherty Stacie L
机构信息
University of Colorado School of Medicine, Aurora, CO, USA.
Adult and Child Consortium for Outcomes Research and Delivery Sciences (ACCORDS), University of Colorado, Aurora, CO, USA.
出版信息
Patient Prefer Adherence. 2023 Mar 23;17:817-826. doi: 10.2147/PPA.S399693. eCollection 2023.
BACKGROUND
The strategies patients use to organize medications (eg, pill dispenser) may be reflected in adherence measured at follow-up. We studied whether medication organization strategies patients use at home are associated with adherence measured using pharmacy-fills, self-report, and pill counts.
DESIGN
Secondary analysis of data from a prospective randomized clinical trial.
SETTING
Eleven US safety-net and community primary care clinics.
PATIENTS
Of the 960 enrolled self-identified non-Hispanic Black and White patients prescribed antihypertensive medications, 731 patients reported pill organization strategies and were included.
VARIABLE
Patients were asked if they use any of the following medication organization strategies: finish previous refills first; use a pill dispenser; combine same prescriptions; or combine dissimilar prescriptions.
OUTCOMES
Adherence to antihypertensive medications using pill counts (range, 0.0-1.0% of the days covered), pharmacy-fill (proportion of days covered >90%), and self-report (adherent/non-adherent).
RESULTS
Of the 731 participants, 38.3% were men, 51.7% were age ≥65, 52.9% self-identified as Black or African American. Of the strategies studied, 51.7% finished previous refills first, 46.5% used a pill dispenser, 38.2% combined same prescriptions and 6.0% combined dissimilar prescriptions. Median (IQR) pill count adherence was 0.65 (0.40-0.87), pharmacy-fill adherence was 75.7%, and self-reported adherence was 63.2%. Those who combined same prescriptions had significantly lower measured pill count adherence than those who did not (0.56 (0.26-0.82) vs 0.70 (0.46-0.90), p<0.01) with no significant difference in pharmacy-fill (78.1% vs 74%, p=0.22) or self-reported adherence (63.0% vs 63.3%, p=0.93).
CONCLUSION
Self-reported medication organization strategies were common. Combining same prescriptions was associated with lower adherence as measured using pill counts but not pharmacy-fills or self-report. Clinicians and researchers should identify the pill organization strategies used by their patients to understand how these strategies may influence measures of patient adherence.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03028597; https://clinicaltrials.gov/ct2/show/NCT03028597 (Archived by WebCite at http://www.webcitation.org/72vcZMzAB).
背景
患者用于整理药物的策略（如药盒）可能会在随访时测得的依从性中有所体现。我们研究了患者在家中使用的药物整理策略是否与通过药房配药、自我报告和药片计数测得的依从性相关。
设计
对一项前瞻性随机临床试验的数据进行二次分析。
地点
美国11家安全网和社区初级保健诊所。
患者
在960名登记的自我认定为非西班牙裔黑人和白人且开具了抗高血压药物的患者中，731名报告了药片整理策略并被纳入研究。
变量
询问患者是否使用以下任何一种药物整理策略：先用完之前的续方；使用药盒；合并相同处方；或合并不同处方。
结果
使用药片计数（涵盖天数的范围为0.0 - 1.0%）、药房配药（涵盖天数>90%的比例）和自我报告（依从/不依从）来衡量抗高血压药物的依从性。
结果
在731名参与者中，38.3%为男性，51.7%年龄≥65岁，52.9%自我认定为黑人或非裔美国人。在所研究的策略中，51.7%先用完之前的续方，46.5%使用药盒，38.2%合并相同处方，6.0%合并不同处方。药片计数依从性的中位数（四分位间距）为0.65（0.40 - 0.87），药房配药依从性为75.7%，自我报告的依从性为63.2%。合并相同处方的患者测得的药片计数依从性显著低于未合并的患者（0.56（0.26 - 0.82）对0.70（0.46 - 0.90），p<0.01），药房配药依从性无显著差异（78.1%对74%，p = 0.22）或自我报告的依从性无显著差异（63.0%对63.3%，p = 0.93）。
结论
自我报告的药物整理策略很常见。合并相同处方与较低的依从性相关，这是通过药片计数测得的，但药房配药或自我报告并非如此。临床医生和研究人员应确定患者使用的药片整理策略，以了解这些策略可能如何影响患者依从性的衡量。
试验注册
ClinicalTrials.gov NCT03028597；https://clinicaltrials.gov/ct2/show/NCT03028597（由WebCite存档于http://www.webcitation.org/72vcZMzAB）。
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