Health system factors and antihypertensive adherence in a racially and ethnically diverse cohort of new users.
Health system factors and antihypertensive adherence in a racially and ethnically diverse cohort of new users.
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DOI：
10.1001/2013.jamainternmed.955
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发表时间：
2013-01-14
影响因子：
39
通讯作者：
Schmittdiel, Julie A.
中科院分区：
文献类型：
--
作者：
Adams, Alyce S.;Uratsu, Connie;Dyer, Wendy;Magid, David;O'Connor, Patrick;Beck, Arne;Butler, Melissa;Ho, P. Michael;Schmittdiel, Julie A.
本研究的目的是在不同的新治疗患者队列中确定潜在的卫生系统解决方案，以解决降压治疗的次优使用。利用Kaiser Permanente北加州的高血压登记，我们对2008年新接受降压治疗的44167名高血压成人（≥18岁）进行了回顾性队列研究。我们使用多变量logistic回归分析分别对种族/民族、特定卫生系统因素和早期不坚持（未能在90天内重新开第一个处方）和不坚持（治疗开始后12个月内至少80%的天数）之间的关系进行建模，并控制了社会人口统计学和临床风险因素。超过30%的患者早期不坚持治疗，五分之一的患者不坚持治疗。非白人更有可能表现出这两种次优服药行为。在调整了社会人口学、临床和卫生系统因素的logistic回归模型中，非白人种族与早期非持久性相关[黑人优势比：1.56(95%可信区间：1.43,1.70)；亚洲OR: 1.40 (95% CI:1.29,1.51)；西班牙裔OR: 1.46 (95% CI:1.35,1.57)]和非依从性，[黑人优势比：1.54 (95% CI:1.35, 1.75)；亚洲OR: 1.13 (95% CI:1.00,1.28)；西班牙裔OR: 1.48 （95% CI:1.33,1.65）。然而，亚洲人和西班牙人早期非持续性的可能性因一线治疗的选择而异。此外，当模型中考虑到药物共付和邮购药房使用时，非依从性的种族和民族差异明显减弱。服药行为的种族和民族差异早在治疗过程中就出现了。然而，旨在减少患者自付费用、易于获得药物和优化初始治疗选择的卫生系统战略可能是缩小在使用这些和其他临床有效疗法方面持续存在的差距的有效工具。
The purpose of this study was to identify potential health system solutions to suboptimal use of antihypertensive therapy in a diverse cohort of newly treated patients. Using a hypertension registry at Kaiser Permanente Northern California, we conducted a retrospective cohort study of 44,167 adults (≥18 years) with hypertension who were new users of antihypertensive therapy in 2008. We used multivariate logistic regression analysis to model the relationships between race/ethnicity, specific health system factors and early non-persistence (failing to refill the first prescription within 90 days) and non-adherence (at least 80% of days covered during the 12 months following start of treatment), respectively, controlling for socio-demographic and clinical risk factors. More than 30% of patients were early non-persistent and one in five were non-adherent to therapy. Non-whites were more likely to exhibit both types of suboptimal medication taking behavior. In logistic regression models adjusting for sociodemographic, clinical and health system factors, non-white race was associated with both early non-persistence [Black Odds Ratio:1.56 (95% Confidence Interval: 1.43, 1.70); Asian OR: 1.40 (95% CI:1.29,1.51); Hispanic OR: 1.46 (95% CI:1.35,1.57)] and non-adherence, [Black Odds Ratio:1.54 (95% CI: 1.35, 1.75); Asian OR: 1.13 (95% CI:1.00,1.28); Hispanic OR: 1.48 (95% CI:1.33,1.65). However, the likelihood of early non-persistence among Asians and Hispanics varied by choice of first line therapy. In addition, racial and ethnic differences in non-adherence were appreciably attenuated when medication copay and mail order pharmacy use were accounted for in the models. Racial and ethnic differences in medication taking behavior occur early in the course of treatment. However, health systems strategies designed to reduce patient copays, ease access to medications and optimize the choice of initial therapy may be effective tools in narrowing persistent gaps in the use of these and other clinically effective therapies.
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