Barriers to and determinants of medication adherence in hypertension management: perspective of the cohort study of medication adherence among older adults.
Barriers to and determinants of medication adherence in hypertension management: perspective of the cohort study of medication adherence among older adults.
复制标题
高血压管理中药物依从性的障碍和决定因素：老年人对药物依从性的队列研究的观点。
DOI：
10.1016/j.mcna.2009.02.007
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Webber LS
中科院分区：
文献类型：
--
作者：
Krousel-Wood MA;Muntner P;Islam T;Morisky DE;Webber LS
抗高血压药物依从性低仍然是公共卫生面临的挑战。了解坚持抗高血压药物依从性的障碍和决定因素可能有助于确定提高依从性和改善结果的干预措施。老年人服药依从性队列研究(COSMO)旨在评估抗高血压药物依从性低的危险因素，探索年龄、性别和种族亚组之间的差异，并确定随着时间的推移，依从性与血压(BP)控制和心血管结果的关系。2006年8月至2007年9月，在COSMO招募了2194名年龄在65岁及以上的服用降压药的参与者，并完成了一项基线电话调查。用Morisky药物依从量表(MMAS)和药物持有率(MPR)评估患者的抗高血压药物依从性。低依从性被定义为MMAS评分<；6；非持久性MPR被定义为<；0.80。血压数据从门诊电子病历中提取；未控制的血压分别定义为收缩压或舒张压，≥分别为140或90毫米汞柱。参与者的平均年龄为75.0±5.6岁，其中58.8%是女性，30.7%是黑人，83.6%的人服用两种或两种以上的降压药。总体而言，14.1%的参与者依从性较低，27.0%的患者出现非持续性的MPR，33.7%的患者血压未得到控制。与MMA高的参与者相比，MMA低的参与者患非持续性MPR的可能性高2.71倍(95%可信区间2.31-3.18)，患失控BP的可能性高1.20倍(95%可信区间1.00-1.43)。抗高血压药物依从性低和血压失控在老年、有保险的患者中很常见。识别实现抗高血压药物依从性的障碍的研究可能有助于开发量身定制的干预措施，以提高药物依从性并改善结果。
Low adherence to antihypertensive medication remains a public health challenge. Understanding barriers to, and determinants of, adherence to antihypertensive medication adherence may help identify interventions to increase adherence and improve outcomes. The Cohort Study of Medication Adherence in Older Adults (CoSMO) is designed to assess risk factors for low antihypertensive medication adherence, explore differences across age, gender, and race subgroups, and determine the relationship of adherence with blood pressure (BP) control and cardiovascular outcomes over time. Between August 2006 and September 2007, 2194 participants, age 65 years and older, taking antihypertensive medication were recruited and enrolled in CoSMO and completed a baseline telephone survey. Antihypertensive medication adherence was assessed with the Morisky Medication Adherence Scale (MMAS) and the medication possession ratio (MPR). Low adherence was defined as a MMAS score < 6; non-persistent MPR was defined as <0.80. BP data were abstracted from outpatient electronic medical records; uncontrolled BP was defined as systolic or diastolic BP ≥140 or 90 mmHg, respectively. The mean age of participants was 75.0 ± 5.6 years, 58.8% were women, 30.7% were black, and 83.6% were taking 2 or more classes of antihypertensive medication. Overall, 14.1% of participants had low adherence, 27.0% had a non-persistent MPR, and 33.7% had uncontrolled BP. Participants with low MMAS were 2.71 (95% confidence interval (CI) 2.31-3.18) times more likely to have non-persistent MPR and 1.20 (95% CI 1.00-1.43) times more likely to have uncontrolled BP than participants with high MMAS. Low antihypertensive medication adherence and uncontrolled blood pressure are common in older, insured patients. Research identifying barriers to achieving antihypertensive medication adherence may assist in developing tailored interventions to increase medication adherence and improve outcomes.
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影响因子：
5
作者：
COHEN, S;KAMARCK, T;MERMELSTEIN, R
通讯作者：
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5
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影响因子：
7.2
作者：
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影响因子：
3.3
作者：
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通讯作者：
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