慢性病管理以改善中风长期幸存者的药物依从性轨迹：一项基于人群的队列研究。
Chronic Disease Management to Enhance Medication Adherence Trajectories in Long-Term Survivors of Stroke: A Population-Based Cohort Study.
作者信息
Dalli Lachlan L, Kilkenny Monique F, Olaiya Muideen T, Ung David, Kim Joosup, Churilov Leonid, Cadilhac Dominique A, Sundararajan Vijaya, Thrift Amanda G, Nelson Mark R, Lannin Natasha A, Barnden Rebecca, Srikanth Velandai, Andrew Nadine E
机构信息
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
出版信息
Pharmacoepidemiol Drug Saf. 2025 May;34(5):e70148. doi: 10.1002/pds.70148.
PURPOSE
Although chronic disease management (CDM) has been reported to improve medication adherence after stroke or transient ischaemic attack (TIA), the impact on specific patterns of medication adherence is unclear. We aimed to evaluate the population effect of receiving a CDM claim on trajectories of medication adherence in long-term survivors of stroke/TIA.
METHODS
A cohort study was undertaken using observational data from PRECISE (42 Australian Stroke Clinical Registry hospitals [Victoria and Queensland; 2012-2015] linked with medication dispensing and primary care claims). Community-dwelling adults with ≥ 1 primary care visit were included. The exposure was a CDM claim (versus no claim) in primary care within 7-18 months post-stroke/TIA. Medication adherence (antihypertensive, antithrombotic, lipid-lowering) was assessed between 19 and 30 months post-stroke/TIA, using group-based trajectory models. Average treatment effects were estimated using multi-level logistic regression with inverse probability treatment weights.
RESULTS
Among 11 580 survivors of stroke/TIA (median age 70 years, 42% female; 45% with CDM claim), four distinct adherence patterns were identified: near-perfect adherence, high adherence, declining adherence, and non-use. After adjustment, having a CDM claim (vs no claim) promoted near-perfect adherence (odds ratio [OR]: 1.16 [95% CI 1.08-1.25]) for antithrombotic medications. Whereas, having a CDM claim (vs no CDM claim) promoted high adherence for antihypertensive (OR: 1.33 [95% CI 1.24-1.44]) or lipid-lowering (OR: 1.26 [95% CI 1.16-1.37]) medications. The odds of non-use were also reduced by 17%-23% in those with (vs without) a CDM claim.
CONCLUSIONS
CDM claims were associated with favourable trajectories of medication adherence in long-term survivors of stroke/TIA.
目的
尽管有报道称慢性病管理（CDM）可提高中风或短暂性脑缺血发作（TIA）后的药物依从性，但对特定药物依从性模式的影响尚不清楚。我们旨在评估获得CDM索赔对中风/TIA长期幸存者药物依从性轨迹的总体影响。
方法
采用来自PRECISE（42家澳大利亚中风临床注册医院[维多利亚州和昆士兰州；2012 - 2015年]与药物配药和初级保健索赔相关联）的观察数据进行队列研究。纳入社区居住且有≥1次初级保健就诊的成年人。暴露因素为中风/TIA后7 - 18个月内在初级保健中提出的CDM索赔（与未提出索赔相比）。在中风/TIA后19至30个月，使用基于组的轨迹模型评估药物依从性（抗高血压、抗血栓、降脂）。使用具有逆概率治疗权重的多级逻辑回归估计平均治疗效果。
结果
在11580名中风/TIA幸存者中（中位年龄70岁，42%为女性；45%提出了CDM索赔），确定了四种不同的依从性模式：近乎完美依从、高依从性、依从性下降和未使用。调整后，提出CDM索赔（与未提出索赔相比）可促进抗血栓药物的近乎完美依从性（优势比[OR]：1.16[95%CI 1.08 - 1.25]）。而提出CDM索赔（与未提出CDM索赔相比）可促进抗高血压药物（OR：1.33[95%CI 1.24 - 1.44]）或降脂药物（OR：1.26[95%CI 1.16 - 1.37]）的高依从性。提出CDM索赔者（与未提出索赔者相比）未使用药物的几率也降低了17% - 23%。
结论
CDM索赔与中风/TIA长期幸存者药物依从性的良好轨迹相关。
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