Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management
Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management
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DOI：
10.2337/dc06-2170
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发表时间：
2007-04-01
期刊：
影响因子：
16.2
通讯作者：
Ross-Degnan, Dennis
中科院分区：
文献类型：
--
作者：
Grant, Richard;Adams, Alyce S.;Ross-Degnan, Dennis
目的：临床惰性已被认为是2型糖尿病患者血糖控制的关键障碍。我们评估了持续升高的糖化血红蛋白水平患者的初始服药依从性和随后的方案强化之间的关系。研究设计和方法--我们分析了2,065名参加保险的2型糖尿病患者的初始队列，这些患者在1992至2001年间刚开始接受降糖治疗，并被跟踪至少3年。用药依从性的评估是通过计算第一种处方降血糖药物的用药天数(从药房记录中)与开出的用药天数(如病历中记录的)的比率来进行的。依从性被测量为从开始服药到至少3个月后测量的下一次Alc结果升高；强化被定义为增加剂量或添加第二种降糖剂。结果：患者年龄(平均+/-SD)55.4+/-12.2岁；53%是男性，19%是黑人。基线服药依从性为79.8+/-19.3%。与依从性最高四分之一的患者相比，依从性最低四分之一的患者在首次Alc升高后12个月内增加方案的可能性显著低于最高四分之一的患者(如果Alc升高，则增加方案的可能性分别为27%和37%，P<；0.001)。在对患者人口统计和治疗因素进行调整的多变量模型中，在糖化血红蛋白升高后，依从性最高的四分位数的患者药物强化的几率增加53%(95%可信区间1.11-1.93，P=0.01)。结论-在A、IC升高的有保险的糖尿病患者中，服药依从性水平预示着随后的药物强化。不良的患者自我管理行为增加了治疗的临床惰性。
OBJECTIVE - Clinical inertia has been identified as a critical barrier to glycemic control in type 2 diabetes. We assessed the relationship between patients' initial medication adherence and subsequent regimen intensification among patients with persistently elevated AlC levels.RESEARCH DESIGN AND METHODS - We analyzed an inception cohort of 2,065 insured patients with type 2 diabetes who were newly started on hypoglycemic therapy and were followed for at least 3 years between 1992 and 2001. Medication adherence was assessed by taking the ratio of medication days dispensed (from pharmacy records) to medication days prescribed (as documented in the medical record) for the first prescribed hypoglycemic drug. Adherence was measured for the period between medication initiation and the next elevated AlC result measured at least 3 months later; intensification was defined as a dose increase or the addition of a second hypoglycemic agent.RESULTS - Patients were aged (mean +/- SD) 55.4 +/- 12.2 years; 53% were men, and 19% were black. Baseline medication adherence was 79.8 +/- 19.3%. Patients in the lowest quartile of adherence were significantly less likely to have their regimens increased within 12 months of their first elevated AlC compared with patients in the highest quartile (27 vs. 37%, respectively, with increased regimens if AlC is elevated, P < 0.001). In multivariate models adjusting for patient demographic and treatment factors, patients in the highest adherence quartile had 53% greater odds of medication intensification after an elevated AlC (95% CI 1.11-1.93, P = 0.01).CONCLUSIONS - Among insured diabetic patients with elevated A I C, level of medication adherence predicted subsequent medication intensification. Poor patient self-management behavior increases therapeutic clinical inertia.