Characteristics of Patients with Primary Non-adherence to Medications for Hypertension, Diabetes, and Lipid Disorders
Characteristics of Patients with Primary Non-adherence to Medications for Hypertension, Diabetes, and Lipid Disorders
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DOI：
10.1007/s11606-011-1829-z
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发表时间：
2012-01-01
影响因子：
5.7
通讯作者：
Steiner, John F.
中科院分区：
文献类型：
--
作者：
Raebel, Marsha A.;Ellis, Jennifer L.;Steiner, John F.
比较领取和不领取处方的患者特征的信息很少，部分原因是使用药房索赔数据库测量的依从性不包括从未领取其第一个处方的患者的信息，即主要不依从的患者。电子健康记录药物订单输入增强了识别主要不依从患者的可能性，并且在具有药物订单输入和药房信息系统的组织中，订单可以链接到分发以识别主要不依从患者。以及原发性不依从患者和正在分发新启动的高血压，糖尿病，和/或高脂血症。这是一项回顾性观察性队列研究。本研究的参与者包括新开始接受抗高血压，抗糖尿病，总体和按治疗类别亚组列出的原发性非依从性患者比例。多变量logistic回归模型被用来调查与原发性非依从性相关的特征，相对于正在进行的dispensing.The主要的非依从性患者的比例不同的治疗类，包括7%的患者订购了抗高血压药，11%订购了抗糖尿病药，13%订购了抗高血压药，5%订购的药物从一个以上的这些治疗类在研究期间。原发性不依从患者的特征在不同治疗类别之间存在差异，但这些特征解释或预测原发性不依从的能力较差（模型c-统计量= 0.61-0.63）。医疗保健服务系统应追求与配药联系起来的药物订单，以确定主要是非遵守病人。我们鼓励进行研究，以确定干预措施成功地减少主要不遵守，从数据库中提供的特征在预测主要不遵守提供帮助不大。
Information comparing characteristics of patients who do and do not pick up their prescriptions is sparse, in part because adherence measured using pharmacy claims databases does not include information on patients who never pick up their first prescription, that is, patients with primary non-adherence. Electronic health record medication order entry enhances the potential to identify patients with primary non-adherence, and in organizations with medication order entry and pharmacy information systems, orders can be linked to dispensings to identify primarily non-adherent patients.This study aims to use database information from an integrated system to compare patient, prescriber, and payment characteristics of patients with primary non-adherence and patients with ongoing dispensings of newly initiated medications for hypertension, diabetes, and/or hyperlipidemia.This is a retrospective observational cohort study.Participants of this study include patients with a newly initiated order for an antihypertensive, antidiabetic, and/or antihyperlipidemic within an 18-month period.Proportion of patients with primary non-adherence overall and by therapeutic class subgroup. Multivariable logistic regression modeling was used to investigate characteristics associated with primary non-adherence relative to ongoing dispensings.The proportion of primarily non-adherent patients varied by therapeutic class, including 7% of patients ordered an antihypertensive, 11% ordered an antidiabetic, 13% ordered an antihyperlipidemic, and 5% ordered medications from more than one of these therapeutic classes within the study period. Characteristics of patients with primary non-adherence varied across therapeutic classes, but these characteristics had poor ability to explain or predict primary non-adherence (models c-statistics = 0.61-0.63).Primary non-adherence varies by therapeutic class. Healthcare delivery systems should pursue linking medication orders with dispensings to identify primarily non-adherent patients. We encourage conduct of research to determine interventions successful at decreasing primary non-adherence, as characteristics available from databases provide little assistance in predicting primary non-adherence.