Sclar D A, Skaer T L, Robison L M, Chin A, Okamoto M P, Nakahiro R K, Gill M A
College of Pharmacy, Washington State University, Pullman 99164-6510.
Clin Auton Res. 1993 Dec;3(6):363-8. doi: 10.1007/BF01829454.
A major barrier to the management of hypertension is the extent to which patients comply with the treatment regimen. Herein we report the findings of a retrospective analysis designed to discern the relationship between antihypertensive formulation, regimen compliance and the utilization of health care services. Data for this analysis were derived from the state of South Carolina's Medicaid computer archive. The study population consisted of 1,000 randomly selected beneficiaries initially prescribed one of the following antihypertensive regimens as monotherapy: atenolol (daily); captopril (twice daily); oral clonidine (twice daily); transdermal clonidine (once a week); diltiazem (twice daily); enalapril (twice daily); metoprolol (twice daily); prazosin (twice daily); terazosin (daily); and verapamil-SR (daily). Multivariate regression analysis was used to determine the incremental influence of selected demographic characteristics, utilization of medical services prior to diagnosis for hypertension, initial antihypertensive medication, medication possession ratio for antihypertensive therapy, and the number of maintenance medications for disease state processes other than hypertension on post-period health care expenditure. Results indicate that patients initially prescribed antihypertensive medication requiring daily or weekly administration experience infrequent changes in their therapeutic regimen, far less use of concomitant therapy for blood pressure control, an increased utilization of antihypertensive medication, and a decrease in the use and cost of physician, hospital and laboratory services.
高血压管理的一个主要障碍是患者对治疗方案的依从程度。在此，我们报告一项回顾性分析的结果，该分析旨在辨别抗高血压药物剂型、治疗方案依从性与医疗服务利用之间的关系。此分析的数据来源于南卡罗来纳州医疗补助计划的计算机存档。研究人群包括1000名随机选取的受益人，他们最初被指定采用以下抗高血压方案之一进行单一疗法治疗：阿替洛尔（每日一次）；卡托普利（每日两次）；口服可乐定（每日两次）；透皮可乐定（每周一次）；地尔硫䓬（每日两次）；依那普利（每日两次）；美托洛尔（每日两次）；哌唑嗪（每日两次）；特拉唑嗪（每日一次）；维拉帕米缓释片（每日一次）。多元回归分析用于确定所选人口统计学特征、高血压诊断前医疗服务的利用情况、初始抗高血压药物、抗高血压治疗的药物持有率以及除高血压外疾病状态过程的维持药物数量对后期医疗保健支出的增量影响。结果表明，最初被指定使用需要每日或每周服用一次抗高血压药物的患者，其治疗方案很少改变，用于血压控制的联合治疗使用较少，抗高血压药物的使用增加，并且医生、医院和实验室服务的使用及成本降低。
