Clinical outcomes and adherence to medication's measured by claims data in patients with diabetes
Clinical outcomes and adherence to medication's measured by claims data in patients with diabetes
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DOI：
10.2337/diacare.27.12.2800
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发表时间：
2004-12-01
期刊：
影响因子：
16.2
通讯作者：
Lafata, JE
中科院分区：
文献类型：
--
作者：
Pladevall, M;Williams, LK;Lafata, JE
目的-虽然不良的药物依从性可能导致糖尿病控制不足，但在常规临床实践中可行地测量依从性的方法尚未建立。本研究进行，以确定是否药房索赔为基础的措施的药物治疗依从性与临床结局在patients.RESEARCH设计和方法-研究设置是一个大型的，综合的交付和金融系统服务的密歇根州东南部的居民。研究人群包括677例随机选择的患者，年龄≥ 18岁，诊断为糖尿病、高胆固醇血症和高血压，在3个研究年（1999-2001年）的每一年至少服用一种降糖、降脂或降压药物。主要的结果指标是HbA（1c），低密度脂蛋白胆固醇水平，血压。结果-非依从性患者的统计学和临床结果比依从性患者差。即使在调整人口统计学和临床特征后，不依从性与HBA（1c）和LDL胆固醇水平显著相关。二甲双胍和他汀类药物不依从性增加10%与HbA（1c）增加0.14%和LDL胆固醇水平增加4.9 mg/dl相关。不遵守ACE抑制剂是没有显着相关的血压。结论-索赔为基础的措施的药物治疗依从性与糖尿病患者的临床结果，因此可能被证明是有用的，在临床实践中。需要更多的研究方法，将基于索赔的依从性测量引入常规临床实践，以及如何使用这些测量来有效地提高慢性病护理管理中的依从性和健康结果。
OBJECTIVE - Although poor medication adherence may contribute to inadequate diabetes control, ways to feasibly measure adherence in routine clinical practice have yet to be established. The present study was conducted to determine whether pharmacy claims-based measures of medication adherence are associated with clinical Outcomes in patients with diabetes.RESEARCH DESIGN AND METHODS - The Study setting was a large, integrated delivery and financial system serving the residents of southeastern Michigan. The study population consisted of 677 randomly selected patients aged greater than or equal to18 years with a diagnosis of diabetes, hypercholesterolemia, and hypertension and who filled at least one prescription for either an antidiabetic, lipid-lowering, or antihypertensive drug in each of the 3 study years (1999-2001). The main outcome measures were HbA(1c), LDL cholesterol levels, and blood pressure.RESULTS - Nonadherent patients had both statistically and clinically worse outcomes than adherent patients. Even after adjusting for demographic and clinical characteristics, nonadherence was significantly associated with HBA(1c) and LDL cholesterol levels. A 10% increase in nonadherence to metformin and statins was associated with an increase of 0.14% in HbA(1c) and an increase of 4.9 mg/dl in LDL cholesterol levels. Nonadherence to ACE inhibitors was not significantly associated with blood pressure.CONCLUSIONS - Claims-based measures of medication adherence are associated With clinical outcomes in patients with diabetes and may therefore prove to be useful in clinical practice. More research is needed on methods to introduce claims-based adherence measurements into routine clinical practice and how to use these measurements to effectively improve adherence and health outcomes in chronic care management.