Suboptimal statin adherence and discontinuation in primary and secondary prevention populations - Should we target patients with the most to gain?
Suboptimal statin adherence and discontinuation in primary and secondary prevention populations - Should we target patients with the most to gain?
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DOI：
10.1111/j.1525-1497.2004.30516.x
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发表时间：
2004-06-01
影响因子：
5.7
通讯作者：
Fendrick, AM
中科院分区：
文献类型：
--
作者：
Ellis, JJ;Erickson, SR;Fendrick, AM
目的：比较一级和二级预防人群的他汀类药物不依从性和停药率，并确定可能影响这些次优服药行为的因素。DSIGN：利用药房索赔和管理数据库进行回顾性队列研究。1998年1月至2001年11月期间，18岁及以上的非Medicaid MCO登记者填写了2个或更多他汀类药物处方;确定了2，258名二级预防患者和2，544名一级预防患者。不依从性的评估是通过没有药物治疗的天数（间隙）与使用活性他汀类药物的天数的百分比来进行的，这种测量方法称为累积多次再填充间隔间隙（CMG）。停药被确定为停止他汀类药物笔芯之前，可用的药房索赔data.RESULTS结束：平均而言，主要和次要组去无药物治疗的时间分别为20.4%和21.5%（P= 0.149）。相对于二级预防队列，一级预防患者更可能停止他汀类药物治疗（相对危险度[RR]，1.24; 95%置信区间[CI]，1.08 - 1.43）。影响不依从和停药的因素有几个。平均每月他汀类药物共付额为10美元但小于或等于20美元和> 20美元的患者中，50%分别在2.2年和1.0年后停药（相对于
OBJECTIVES: To compare statin nonadherence and discontinuation rates of primary and secondary prevention populations and to identify factors that may affect those suboptimal medication-taking behaviors.DSIGN: Retrospective cohort utilizing pharmacy claims and administrative databases.SETTING: A midwestern U.S. university-affiliated hospital and managed care organization (MCO).PATIENTS: Non-Medicaid MCO enrollees, 18 years old and older, who filled 2 or more statin prescriptions from January 1998 to November 2001; 2,258 secondary and 2,544 primary prevention patients were identified.MEASUREMENTS: Nonadherence was assessed by the percent of days without medication (gap) over days of active statin use, a measurement known as cumulative multiple refill-interval gap (CMG). Discontinuation was identified by cessation of statin refills prior to the end of available pharmacy claims data.RESULTS: On average, the primary and secondary groups went without medication 20.4% and 21.5% of the time, respectively (P= .149). Primary prevention patients were more likely to discontinue statin therapy relative to the secondary prevention cohort (relative risk [RR], 1.24; 95% confidence interval [CI], 1.08 to 1.43). Several factors influenced nonadherence and discontinuation. Fifty percent of patients whose average monthly statin copayment was $10 but less than or equal to$20 and >$20 discontinued by 2.2 and 1.0 years, respectively (RR, 1.39 and 4.30 relative to