Alcohol Screening Scores and Medication Nonadherence
Alcohol Screening Scores and Medication Nonadherence
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DOI：
10.7326/0003-4819-149-11-200812020-00004
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发表时间：
2008-12-02
影响因子：
39.2
通讯作者：
Bradley, Katharine A.
中科院分区：
文献类型：
--
作者：
Bryson, Chris L.;Au, David H.;Bradley, Katharine A.
背景：药物治疗不依从性很常见，并与不良结局相关。酒精滥用可能是一个危险因素，为nonadhesion;然而，证据是limited.Objective：要确定是否酒精滥用，确定了一个简单的筛选工具，是在一个剂量反应的方式与增加风险的药物治疗nonadhesion在退伍军人参加primary care clinics.Design：二次分析队列数据收集前瞻性从1997年至2000年的一部分，随机对照试验。设定：参与者：5473例服用他汀类药物的患者，3468例口服降糖药的患者，和13 729例服用抗高血压药物的患者。测量：患者完成了酒精使用障碍识别测试消费（AUDIT-C）问卷，一个有效的3问题酒精滥用筛选测试。他们的分数分为不饮酒者;低水平的酒精使用;轻度，中度和重度酒精滥用。药物依从性，定义为至少80%的观察日有药物可用，从酒精筛查日期后90天或1年的药房记录中测量。Logistic回归被用来估计预测的比例，在每个AUDIT-C组和人口统计学和临床covariates.Results调整的依从性患者治疗的高血压和高脂血症的比例谁是非依从性增加较高的AUDIT-C评分。对于他汀类药物的1年依从性，2个最高酒精滥用组中依从性患者的百分比（依从性患者的校正百分比，58% [95% CI，52%至65%]和55% [ CI，47%至63%]）低于非饮酒者组（66% [ CI，64%至68%]）。对于1年的抗高血压方案依从性，3个最高酒精滥用组中依从性患者的百分比较低（调整后的依从性患者百分比，61% [ CI，58%至64%]; 60% [ CI，56%至63%];和56% [ CI，52%至60%]）比非饮酒者组（64% [ CI，63%至65%]）。在调整后的analys.Limitation：这项观察性研究不能解决是否饮酒的变化导致的变化在adherence和可能无法推广到其他population.Conclusion：酒精滥用，通过一个简短的筛选问卷测量，与药物治疗不依从性的风险增加。
Background: Medication nonadherence is common and is associated with adverse outcomes. Alcohol misuse may be a risk factor for nonadherence; however, evidence is limited.Objective: To identify whether alcohol misuse, as identified by a simple screening tool, is associated in a dose-response manner with increased risk for medication nonadherence in veterans attending primary care clinics.Design: Secondary analysis of cohort data collected prospectively from 1997 to 2000 as part of a randomized, controlled trial. Setting: 7 Veterans Affairs primary care clinics.Participants: 5473 patients taking a statin, 3468 patients taking oral hypoglycemic agents, and 13 729 patients taking antihypertensive medications.Measurements: Patients completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questionnaire, a validated 3-question alcohol misuse screening test. Their scores were categorized into nondrinkers; low-level alcohol use; and mild, moderate, and severe alcohol misuse. Medication adherence, defined as having medications available for at least 80% of the observation days, was measured from pharmacy records for either 90 days or 1 year after the alcohol screening date. Logistic regression was used to estimate the predicted proportions of adherent patients in each AUDIT-C group and adjusted for demographic and clinical covariates.Results: The proportion of patients treated for hypertension and hyperlipidemia who were nonadherent increased with higher AUDIT-C scores. For 1-year adherence to statins, the percentage of adherent patients was lower in the 2 highest alcohol misuse groups ( adjusted percentage of adherent patients, 58% [95% CI, 52% to 65%] and 55% [ CI, 47% to 63%]) than in the nondrinker group (66% [ CI, 64% to 68%]). For 1-year adherence to antihypertensive regimens, the percentage of adherent patients was lower in the 3 highest alcohol misuse groups ( adjusted percentage of adherent patients, 61% [ CI, 58% to 64%]; 60% [ CI, 56% to 63%]; and 56% [ CI, 52% to 60%]) than in the nondrinker group ( 64% [ CI, 63% to 65%]). No statistically significant differences were observed for oral hypoglycemics in adjusted analyses.Limitation: This observational study cannot address whether changes in drinking lead to changes in adherence and may not be generalizable to other populations.Conclusion: Alcohol misuse, as measured by a brief screening questionnaire, was associated with increased risk for medication nonadherence.