Hypertension treatment in a medicare population: Adherence and systolic blood pressure control
Hypertension treatment in a medicare population: Adherence and systolic blood pressure control
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DOI：
10.1016/j.clinthera.2007.05.010
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发表时间：
2007-05-01
影响因子：
3.2
通讯作者：
Hsu, John
中科院分区：
文献类型：
--
作者：
Fung, Vicki;Huang, Jie;Hsu, John
背景：尽管有大量试验证据证明了药物治疗对降低血压（BP）和心血管事件的有效性，但许多患者对其高血压治疗不遵守。目标：这项研究的目的是检查使用药物使用药房的患者依从性，数据（即门诊，住院和邮购处方）以及依从性测量与收缩BP之间的关联（SBP）控制。方法：该研究包括Medicare+Choice受益人（年龄> = 65岁），他们在2003年不断入学，并在2002年记录了高血压并接受了> = 1个高血压药物。此分析使用了自动化的临床数据和2000年美国人口普查。我们估计了2003年使用分配药物在几天内（覆盖的天数> = 80％的比例）估算了2次高血压治疗依从性的测量值：（1）遵守> = 1 = 1高血压药物； （2）遵守全部高血压治疗方案。我们通过2002年同时使用的高血压药物的数量来定义该方案。我们每年评估了SBP测量前的30、60和90天的依从性。逻辑回归用于检查高血压方案中的依从性与药物数量之间的关联，以及依从性和SBP升高（> = 140 mm Hg）之间的关联。我们针对患者的社会人口统计学和临床特征进行了调整。分析：大多数（52.8％）患有多药高血压治疗方案。在2003年，有87.3％的受试者遵守> = 1个高血压药物； 72.1％的人遵守他们的完整方案。调整后，我们发现具有多药方案的受试者更有可能粘附于> = 1药物，并且与1-药治疗方案的患者相比，遵守其全方案的可能性明显更低。超过三分之一的受试者在2003年的SBP升高。这两种依从性措施均与SBP升高的几率有关（例如，优势比= 0.87 [95％Cl，0.84-0.89]，以遵守完整方案）。对于具有多药治疗方案的受试者，部分依从性和对该方案的不遵守性与SBP升高的几率有关：使用自动化药房数据的依从性措施可以识别对其药物治疗方案不依赖的患者，并且更有可能不足以识别不足的患者受控的BP。依从性衡量了患者药物方案中药物数量的数量，可能有助于确定由于部分治疗依从性而导致的额外BP结局差的患者。
Background: Despite substantial trial evidence that demonstrates the effectiveness of pharmacologic treatment for reducing blood pressure (BP) and cardiovascular events, many patients are nonadherent to their hypertension treatment.Objectives: The purpose of this study was to examine patient adherence to hypertension medications using pharmacy data (ie, outpatient, inpatient, and mail-order prescriptions) and the association between adherence measures and systolic BP (SBP) control.Methods: The study included Medicare+Choice beneficiaries (aged >= 65 years) who were continuously enrolled in an integrated delivery system in 2003, and who had documented hypertension and received >= 1 hypertension drug in 2002. This analysis used automated clinical data and the 2000 US Census. We estimated 2 measures of hypertension treatment adherence in 2003 using the supply of dispensed drugs in days (proportion of days covered >= 80%): (1) adherence to >= 1 hypertension drug; and (2) adherence to the full hypertension treatment regimen. We defined the regimen by the number of hypertension drugs used concurrently in 2002. We assessed adherence annually and during the 30, 60, and 90 days before an SBP measurement. Logistic regression was used to examine the association between adherence and the number of drugs in the hypertension regimen, as well as the association between adherence and elevated SBP (>= 140 mm Hg). We adjusted for patient sociodemographic and clinical characteristics.Results: The majority (52.8%) of patients had multi-drug hypertension regimens. In 2003, 87.3% of subjects were adherent to >= 1 hypertension drug; 72.1% were adherent to their full regimen. After adjustment, we found that subjects with multidrug regimens were significantly more likely to be adherent to >= 1 drug and significantly less likely to be adherent to their full regimen, compared with patients on a 1-drug regimen. Over one-third of subjects had elevated SBP in 2003. Both adherence measures were associated with lower odds of having elevated SBP (eg, odds ratio = 0.87 [95% Cl, 0.84-0.89] for adherence to the full regimen). For subjects with multidrug regimens, partial adherence and nonadherence to the regimen were associated with higher odds of having elevated SBP.Conclusions: Adherence measures using automated pharmacy data can identify patients who are nonadherent to their drug treatment regimen and who are more likely to have inadequately controlled BP. Adherence measures that account for the number of drugs in a patients' drug regimen might help identify additional patients at risk for poor BP outcomes due to partial treatment adherence.