Predictors of Compliance with Anti hypertensive Therapy in a High-Risk Medicaid Population
Predictors of Compliance with Anti hypertensive Therapy in a High-Risk Medicaid Population
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DOI：
10.1016/s0027-9684(15)30808-7
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发表时间：
2009-01-01
影响因子：
3.3
通讯作者：
Weir, Matthew R.
中科院分区：
文献类型：
--
作者：
Shaya, Fadia T.;Du, Dongyi;Weir, Matthew R.
目的：确定医疗补助人群抗高血压联合治疗依从性的预测因素。方法：回顾性分析2002年1月1日至2004年12月31日期间接受血管紧张素转换酶抑制剂(ACEIs)/氢氯噻嗪类药物（HCTZs）或ACEI/钙通道阻滞剂固定剂量联合用药或单独用药的马里兰州医疗补助患者的医疗和药房索赔数据。纳入：连续入组18岁及以上患者，随访至少1年。排除：2002年1月1日至2002年6月30日期间使用固定剂量联合抗高血压药物（以确定事件队列）。依从性定义为药物占有率大于或等于80%。使用多变量logistic回归来预测依从性作为年龄、性别、种族、合并症（Charlson共病指数[CCI]）的函数，以及固定剂量联合用药或单独用药。结果：568例患者中，女性占63.73%，非裔美国人占68.83%，中位年龄52岁，固定剂量联合用药占35.56%，开始使用ACEI/HCTZ的占72.89%，接受治疗的占24.82%。年龄小于40岁的患者（OR, 0.38; p = 0.01; 95% CI, 0.18-0.81）和非裔美国人（OR, 0.45; p = 0.0004; 95% CI, 0.29-0.70）的依从性分别低于年龄大于60岁的患者和白种人。CCI为1的患者（OR, 2.11; p = 0.05; 95% Cl, 1.01-4.40）和固定剂量联合用药的患者（OR, 1.60; p = 0.02, 95% Cl, 1.06-2.40）比CCI较高和单独用药的患者更容易依从。结论：年龄、种族、合并症和简化降压方案是依从性的重要预测因素。较高的依从率可能会提高心血管疾病的治疗效果。
Objective: To identify predictors of compliance with antihypertensive combination therapy in a Medicaid population.Methods: Retrospective medical and pharmacy claims data for Maryland Medicaid patients receiving angiotensin converting enzyme inhibitors (ACEIs)/hydrochlorothiazides (HCTZs) or ACEI/calcium channel blockers as fixed-dose combinations or separate agents during the period of January 1, 2002 to December 31, 2004, were analyzed.Inclusion: Continuously enrolled patients 18 years and older and at least one year of follow-up.Exclusion: Use of fixed-dose combination antihypertensives between January 1, 2002 and June 30, 2002 (to identify incident cohort). Compliance was defined as medication possession ratio greater than or equal to 80%. Multivariate logistic regression was used to predict compliance as a function of age, gender, race, comorbidities (Charlson Comorbidity Index [CCI]), and use of either fixed-dose combination or separate agents.Results: There were 568 patients, 63.73% female, 68.83% African American, median age 52 years, 35.56% on fixed-dose combinations, 72.89% started on ACEI/HCTZ, and 24.82% complied with therapy. Patients younger than 40 years (OR, 0.38; p =.01; 95% CI, 0.18-0.81) and African American (OR, 0.45; p =.0004; 95% CI, 0.29-0.70) were less likely to be compliant than patients older than 60 years and Caucasian, respectively. Patients With a CCI of 1 (OR, 2.11; p =.05; 95% Cl, 1.01-4.40) and those on fixed-dose combinations (OR, 1.60; p =.02, 95% Cl, 1.06-2.40) were more likely to be compliant than those With higher CCIs and on separate agents, respectively.Conclusion: Age, race, comorbidities, and simplified antihypertensive regimens were significant predictors of compliance. Higher compliance rates may enhance cardiovascular disease management outcomes.