Determinants of compliance with statin therapy and low-density lipoprotein cholesterol goal attainment in a managed care population.
Determinants of compliance with statin therapy and low-density lipoprotein cholesterol goal attainment in a managed care population.
复制标题
管理护理人群中他汀类药物治疗依从性和低密度脂蛋白胆固醇目标实现的决定因素。
DOI：
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发表时间：
2005
影响因子：
3.2
通讯作者：
Jay W Meyer
中科院分区：
文献类型：
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作者：
J. Schultz;J. O'donnell;K. Mcdonough;R. Sasane;Jay W Meyer
目标
确定药物依从性和低密度脂蛋白胆固醇目标实现的决定因素。
研究设计
这项回顾性分析使用了来自大型全国性就业独立执业协会数据库的索赔数据。根据1999年4月1日至2001年6月30日之间是否存在他汀类药物治疗的处方来确定受试者。受试者必须年满18岁，连续参加健康计划2年，并且是他汀类药物治疗的新使用者。
方法
使用多变量逻辑回归模型来确定高风险受试者的依从性和目标实现的预测因素。
结果
随着他汀类药物平均共付额的增加，依从性的可能性下降。在具有实验室结果的受试者中，50.7% 达到了国家胆固醇教育计划成人治疗小组 III 指南制定的低密度脂蛋白胆固醇目标水平。老年个体和男性更有可能达到低密度脂蛋白胆固醇目标，遵守他汀类药物治疗的个体也是如此。
结论
在管理式医疗机构中，他汀类药物治疗的依从性仍然较差。特别值得关注的是，女性和年轻高危患者的依从性较低，以及与高脂血症相关的门诊就诊次数较少和胆固醇检测发生率较低的患者。
OBJECTIVE
To identify determinants of medication compliance and low-density lipoprotein cholesterol goal attainment.
STUDY DESIGN
This retrospective analysis used claims data from a large, national, employment-based independent practice association database. Subjects were identified based on the existence of a filled prescription for statin therapy between April 1, 1999, and June 30, 2001. Subjects had to be 18 years or older, continuously enrolled in the health plan for 2 years, and new users of statin therapy.
METHODS
Multivariate logistic regression models were used to identify predictors of compliance and goal attainment in high-risk subjects.
RESULTS
As the mean copayment for statins increased, there was a decrease in the likelihood of compliance. Of the subjects with laboratory results, 50.7% attained their low-density lipoprotein cholesterol goal level established by National Cholesterol Education Program Adult Treatment Panel III guidelines. Older individuals and men were more likely to reach their low-density lipoprotein cholesterol target goal, as were individuals who were compliant with their statin therapy.
CONCLUSIONS
Compliance with statin therapy in the managed care setting remains poor. Of particular concern is the lower level of compliance among women and younger high-risk patients, along with patients who have fewer outpatient visits associated with hyperlipidemia and lower incidences of cholesterol testing.