Bloom B S
Department of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia 19104-2676, USA.
Clin Ther. 1998 Jul-Aug;20(4):671-81. doi: 10.1016/s0149-2918(98)80130-6.
This paper describes use of the prescription records of a large pharmaceutical benefits management organization to retrospectively analyze the refill behavior of patients who have recently started antihypertensive therapy in the outpatient setting. Using logistic regression analysis, the author identified class of antihypertensive medication, patient age, and dosing frequency as clinically important independent covariates that are predictive of persistence (defined as continuing therapy with the original antihypertensive drug as originally prescribed) at 12 months. At 12 months' follow-up, the percentage of patients continuing initial angiotensin II (A-II) antagonist therapy was substantially higher than the percentage continuing therapy with angiotensin-converting enzyme inhibitors, calcium antagonists, beta-blockers, or thiazide diuretics (64% vs 58%, 50%, 43%, and 38%, respectively). Additional studies are needed to explain why more patients continued with the same A-II antagonist therapy at 12 months compared with the other classes of antihypertensive drugs; whether these findings are explained by drug tolerability, financial incentives, newness of the product, selection bias, or other factors; whether these differences will be maintained in the following years; and whether the differences are associated with better health outcomes.
本文描述了利用一家大型药品福利管理机构的处方记录，对近期在门诊开始抗高血压治疗的患者的续方行为进行回顾性分析。通过逻辑回归分析，作者确定抗高血压药物类别、患者年龄和给药频率是在12个月时预测持续性（定义为继续使用最初处方的原抗高血压药物进行治疗）的重要临床独立协变量。在12个月的随访中，继续初始血管紧张素II（A-II）拮抗剂治疗的患者百分比显著高于继续使用血管紧张素转换酶抑制剂、钙拮抗剂、β受体阻滞剂或噻嗪类利尿剂治疗的患者百分比（分别为64%对58%、50%、43%和38%）。需要进一步研究来解释为什么与其他抗高血压药物类别相比，更多患者在12个月时继续使用同一种A-II拮抗剂治疗；这些发现是否可以用药物耐受性、经济激励、产品新颖性、选择偏倚或其他因素来解释；这些差异在接下来的几年中是否会持续；以及这些差异是否与更好的健康结果相关。
