Prospective Analysis of LDL-C Goal Achievement and Self-Reported Medication Adherence Among Statin Users in Primary Care
Prospective Analysis of LDL-C Goal Achievement and Self-Reported Medication Adherence Among Statin Users in Primary Care
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DOI：
10.1016/j.clinthera.2011.07.007
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发表时间：
2011-09-01
影响因子：
3.2
通讯作者：
Ledwidge, Mark
中科院分区：
文献类型：
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作者：
Bermingham, Margaret;Hayden, John;Ledwidge, Mark
背景：在过去的十年中，由于阿托伐他汀和瑞舒伐他汀等有效的他汀类药物的引入，LDL-C水平的控制得到了改善。然而，许多患者没有达到他们的LDL-C目标，这给临床医生提出了一个实际的困境，并强调需要以临床相关的方式识别依从性问题。目的：本研究的目的是评估LDL-C目标实现与药物依从性和信念之间的关系。方法：所有患者年龄为bb0 = 40岁，参加心血管危险因素管理项目STOP-HF （St. Vincent's Screening To Prevent Heart Failure study）。185名服用他汀类药物的参与者，分为达到和未达到LDL-C目标的两组，随机选择参加一项前瞻性研究，通过Morisky药物依从性量表（MMAS）评估依从性与LDL-C目标实现之间的关系。采用BMQ-G （belief about medicines Questionnaire General）量表评估患者对药物的信念。主要结果测量指标是使用MMAS的患者LDL-C目标实现和药物依从性的预测因子以及依从性的预测因子。结果：入选患者平均年龄64.9（9.9）岁；其中45%为男性，46%患有高血压，17.5%患有冠状动脉疾病，10%患有糖尿病。119例患者接受问卷调查，其中71例（59.7%）达到目标。119例患者接受问卷调查，其中71例（59.7%）达到目标。LDL-C达到目标者比未达到目标者更有可能回答问卷（76.8% vs 52.7%; P = 0.002）。58名应答者（48.7%）报告说他们没有完全坚持服药，在多变量分析中，与那些坚持服药的人相比，他们错过LDL-C目标的可能性是后者的两倍。大约25%的不遵医嘱患者是故意不遵医嘱的。患者对药物的信念是自我报告依从性的重要预测因子，但不是LDL-C目标实现的重要预测因子。结论：在许多服用他汀类药物的患者中，药物不依从可能导致无法达到治疗目标。在常规临床护理中，结构化的MMAS问卷可以为临床医生提供一个有效的工具来评估他汀类药物治疗失败情况下的药物不依从性。STOP-HF ClinicalTrials.gov标识符：NCT00921960。(C) 2011 Elsevier HS Journals, Inc.；版权所有。
Background: Improvements in the control of LDL-C levels have occurred in the past decade due to the introduction of increasingly potent statins, such as atorvastatin and rosuvastatin. Many patients, however, do not achieve their LDL-C goals, which presents a practical dilemma for clinicians and highlights the need to identify adherence problems in a clinically relevant manner.Objective: The purpose of this study was to evaluate the relationship between LDL-C goal achievement and both medication adherence and beliefs assessed using structured questioning.Methods: All patients were aged >= 40 years and participated in the cardiovascular risk factor management program STOP-HF (St. Vincent's Screening To Prevent Heart Failure study). One hundred and eighty-five participants who had been prescribed statins, split between those who achieved and those who did not achieve LDL-C goal, were randomly selected for a prospective study examining the relationship between adherence, assessed by the Morisky Medication Adherence Scale (MMAS), and LDL-C goal achievement. Patients' beliefs about medicines were assessed using the Beliefs about Medicines Questionnaire General (BMQ-G). Main outcome measures were predictors of LDL-C goal achievement and medication adherence and predictors of adherence among patients using the MMAS.Results: The average age of the selected patients was 64.9 (9.9) years; 45% were male, 46% had hypertension, 17.5% had coronary artery disease, and 10% had diabetes. Questionnaires were answered by 119 patients, 71 of whom (59.7%) were goal achievers. Questionnaires were answered by 119 patients, 71 of whom (59.7%) were goal achievers. LDL-C goal achievers were more likely to respond to the questionnaires than nonachievers (76.8% vs 52.7%; P = 0.002). Fifty-eight respondents (48.7%) reported that they were not fully adherent to medication and in multivariable analysis were twice as likely to miss LDL-C goal compared with those who were adherent. Approximately 25% of patients who reported nonadherence were intentionally so. Patients' beliefs about medicines were a significant predictor of self-reported adherence but not of LDL-C goal achievement.Conclusions: Medication nonadherence may be responsible for failure to achieve goal in many patients who are prescribed statins. In routine clinical care, the structured MMAS questionnaire may provide clinicians with an effective tool to assess medication nonadherence in the context of statin therapy failure. STOP-HF ClinicalTrials.gov identifier: NCT00921960. (Clin Ther. 2011;33:1180-1189) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.