When more is not better - Treatment intensification among hypertensive patients with poor medication adherence
When more is not better - Treatment intensification among hypertensive patients with poor medication adherence
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DOI：
10.1161/circulationaha.107.724104
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发表时间：
2008-06-03
期刊：
影响因子：
37.8
通讯作者：
Kerr, Eve A.
中科院分区：
文献类型：
--
作者：
Heisler, Michele;Hogan, Mary M.;Kerr, Eve A.
背景 - 高血压可能控制不佳，因为患者不服药（依从性差）或因为提供者没有在适当时增加药物（缺乏药物强化或“临床惰性”）。我们检查了患者依从性和提供者治疗强化之间的关系。 方法和结果 - 我们对在退伍军人事务部 (VA) 医疗机构中西部 VA 行政区域服用 1 种或多种血压 (BP) 药物处方的高血压患者进行了一项回顾性队列研究。我们的样本包括 2004 年期间至少接受过 2 次门诊血压药物补充并在 2005 年期间接受过 1 次或多次门诊初级保健且收缩压升高 >140 但 90 mm Hg 的所有患者 (n = 38 327)。对于 2005 年期间的每次血压升高事件（68 610 起事件），我们使用电子药房补充数据来检查患者在过去 12 个月内的血压药物依从性以及提供者是否增加剂量或添加血压药物（“强化”）。多变量分析解释了患者体内血压升高事件的聚集，并根据患者年龄、合并症、血压药物数量、遭遇收缩压和上一年的平均收缩压进行了调整。在 68 610 起血压升高事件中，医疗服务提供者对 30% 的患者强化了药物治疗，无论患者的血压药物依从性好坏，强化治疗几乎没有变化。调整后，有“差距”的患者的强化率为 31%
Background - Hypertension may be poorly controlled because patients do not take their medications (poor adherence) or because providers do not increase medication when appropriate (lack of medication intensification, or "clinical inertia"). We examined the prevalence of and relationship between patient adherence and provider treatment intensification.Methods and Results - We used a retrospective cohort study of hypertensive patients who had filled prescriptions for 1 or more blood pressure (BP) medications at Veterans' Affairs (VA) healthcare facilities in a Midwestern VA administrative region. Our sample included all patients who received at least 2 outpatient BP medication refills during 2004 and had 1 or more outpatient primary care visits with an elevated systolic BP >140 but 90 mm Hg during 2005 (n = 38 327). For each episode of elevated BP during 2005 (68 610 events), we used electronic pharmacy refill data to examine patients' BP medication adherence over the prior 12 months and whether providers increased doses or added BP medications("intensification"). Multivariate analyses accounted for the clustering of elevated BP events within patients and adjusted for patient age, comorbidities, number of BP medications, encounter systolic BP, and average systolic BP over the prior year. Providers intensified medications in 30% of the 68 610 elevated BP events, with almost no variation in intensification regardless of whether patients had good or poor BP medication adherence. After adjustment, intensification rates were 31% among patients who had "gaps" of