Bailey J E, Lee M D, Somes G W, Graham R L
Department of Medicine, University of Tennessee, Memphis, USA.
Clin Ther. 1996 Nov-Dec;18(6):1252-62. doi: 10.1016/s0149-2918(96)80080-4.
Antihypertensive medication noncompliance is common and leads to substantial morbidity for patients and increased health care costs for managed-care organizations. A retrospective cohort study using pharmacy prescription profiles to estimate noncompliance was conducted to determine important risk factors for patient noncompliance with antihypertensive therapy for Medicaid enrollees participating in a managed-care plan. The pharmacy and claims data for 1395 patients with uncomplicated hypertension who were enrollees of Tennessee's Medicaid managed-care program were analyzed to determine the frequency of the enrollees' failure to obtain timely antihypertensive medication refills (hereafter referred to as refill failure) and to identify the predictors of refill failure. Overall, refill failure occurred in 33% of 7413 refill opportunities studied, whereas refill failure occurred in 32% of the cases in which medication was dosed once daily and in 35% of the cases in which medication was dosed more than once daily. For patients taking alpha-blockers, there was a significantly lower rate of refill failure (11.0%) than for patients taking angiotensin-converting enzyme inhibitors, direct vasodilators, and thiazide diuretics. Patients taking calcium channel blockers, had a significantly lower rate of refill failure (38.5%) than for patients taking thiazide diuretics (45.5%). Younger age, medication class, multiple-daily dosing regimen, and fewer provider visits were all found to be significant independent predictors of refill failure, whereas gender and regimen complexity were not significant predictors in this population. Health care systems planning pharmacy-based interventions to improve patient compliance with antihypertensive medication for patients in a Medicaid managed-care program can expect to encounter high levels of refill failure and may want to target enrollee subgroups by age, medication class, or dosing regimen for intensive intervention efforts.
抗高血压药物治疗依从性不佳的情况很常见，这会给患者带来严重的发病率，并增加管理式医疗组织的医疗成本。我们进行了一项回顾性队列研究，利用药房处方记录来估计不依从情况，以确定参与管理式医疗计划的医疗补助受助人不依从抗高血压治疗的重要风险因素。我们分析了田纳西州医疗补助管理式医疗计划的1395名无并发症高血压患者的药房和理赔数据，以确定受助人未能及时获得抗高血压药物续方（以下简称续方失败）的频率，并确定续方失败的预测因素。总体而言，在研究的7413次续方机会中，33%出现了续方失败，而每日给药一次的病例中32%出现了续方失败，每日给药多次的病例中35%出现了续方失败。对于服用α受体阻滞剂的患者，续方失败率（11.0%）显著低于服用血管紧张素转换酶抑制剂、直接血管扩张剂和噻嗪类利尿剂的患者。服用钙通道阻滞剂的患者续方失败率（38.5%）显著低于服用噻嗪类利尿剂的患者（45.5%）。年龄较小、药物类别、每日多次给药方案以及看诊医生次数较少均被发现是续方失败的重要独立预测因素，而性别和用药方案复杂性在该人群中并非显著预测因素。对于在医疗补助管理式医疗计划中为改善患者抗高血压药物治疗依从性而规划基于药房的干预措施的医疗系统而言，预计会遇到较高水平的续方失败情况，可能需要针对年龄、药物类别或给药方案等受助人群亚组进行强化干预。
