Prescriber Continuity and Medication Adherence for Complex Patients
Prescriber Continuity and Medication Adherence for Complex Patients
复制标题
DOI：
10.1177/1060028014563266
复制
发表时间：
2015-03-01
影响因子：
2.9
通讯作者：
Maciejewski, Matthew L.
中科院分区：
文献类型：
--
作者：
Hansen, Richard A.;Voils, Corrine I.;Maciejewski, Matthew L.
背景：药物依从性是治疗心血管代谢疾病的一个关键方面，包括糖尿病、高血压、血脂异常和心力衰竭。患有多种心脏代谢疾病和多种处方的患者可能会增加不依从性的风险。目的：本研究的目的是检查开处方者的数量、病情的数量和重新坚持口服药物治疗心脏代谢疾病之间的关系。方法：在这项回顾性队列研究中，7933名退伍军人被确定为1至4种心脏代谢疾病。对治疗糖尿病、高血压和血脂异常的口服药物的补充依从性采用基于行政索赔的连续多次间隔间隔（CMG）来测量，该间隔间隔估计患者不服用药物的天数百分比。我们将每一种情况的续药依从性分为CMG = 4个处方者（优势比[OR] = 0.69; 95% CI = 0.59-0.80），但心脏代谢疾病的数量并不是一个显著的预测因子。服用>= 3名处方者（OR = 0.80; 95% Cl = 0.70-0.92）或>= 4名处方者（OR = 0.77; 95% Cl = 0.64-0.91）的患者抗血脂异常补药依从性较低。相反，抗血脂异常补液依从性随着心脏代谢疾病的数量而提高，但差异仅在疾病方面具有统计学意义（OR = 1.31; 95% CI = 1.09-1.57）。在多变量回归模型中，病情数量和开处方者数量并不是糖尿病患者续药依从性的显著预测因子。结论：对复杂患者的护理和用药方案的有效管理仍然是一个未解决的挑战，但这些结果表明，至少对于高血压和血脂异常患者，通过减少参与患者护理的开处方者的数量，可能会提高药物补充依从性。
Background: Medication adherence is a critical aspect of managing cardionnetabolic conditions, including diabetes, hypertension, dyslipidemia, and heart failure. Patients who have multiple cardionnetabolic conditions and multiple prescribers may be at increased risk for nonadherence. Objective: The purpose of this study was to examine the relationship between number of prescribers, number of conditions, and refill adherence to oral medications to treat cardiometabolic conditions. Methods: In this retrospective cohort study, 7933 veterans were identified with 1 to 4 cardionnetabolic conditions. Refill adherence to oral medications for diabetes, hypertension, and dyslipidemia was measured using an administrative claims based continuous multiple-interval gap (CMG) that estimates the percentage of days a patient did not possess medication. We dichotomized refill adherence for each condition as a CMG = 4 prescribers (odds ratio [OR] = 0.69; 95% CI = 0.59-0.80), but the number of cardiometabolic conditions was not a significant predictor. Antidyslipidemia refill adherence was lower in patients seeing >= 3 prescribers (OR = 0.80; 95% Cl = 0.70-0.92) or >= 4 prescribers (OR = 0.77; 95% Cl = 0.64-0.91). Conversely, antidyslipidemia refill adherence improved with the number of cardiometabolic conditions, but differences were only statistically significant for conditions (OR = 1.31; 95% CI = 1.09-1.57). In multivariate regression models, the number of conditions and number of prescribers were not significant predictors of refill adherence in the group of patients with diabetes. Conclusions: Effective management of care and medication regimens for complex patients remains an unresolved challenge, but these results suggest that medication refill adherence might be improved by minimizing the number of prescribers involved in a patient's care, at least for hypertension and dyslipidemia.