Persistence of use of lipid-lowering medications - A cross-national study
Persistence of use of lipid-lowering medications - A cross-national study
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DOI：
10.1001/jama.279.18.1458
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发表时间：
1998-05-13
影响因子：
120.7
通讯作者：
LeLorier, J
中科院分区：
文献类型：
--
作者：
Avorn, J;Monette, J;LeLorier, J
背景。-尽管临床试验已经证明了降脂疗法的好处，但人们对这些药物在普通人群中是如何开出或使用的知之甚少。目的-在美国和加拿大的典型人群中评估降脂药物方案持续治疗的预测因素。设计-一项队列研究，定义了一年内所有服用降脂药物的处方，以及患者的人口统计和临床特征。设置。-新泽西州的老年人和残疾人医疗补助和药房援助计划以及魁北克省的医疗保健计划。患者。-所有连续登记的65岁以上的患者，他们开了一张或多张降脂药物的处方(美国计划中N=5611，从魁北克10%的样本中N=1676)。主要结果衡量标准。-研究年度中患者服用降脂药物处方的天数比例；结果：在两个人群中，患者在研究一年中有大约40%的时间没有满足降脂药物的处方。使用3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂的存留率显著高于使用氯乙胺组(分别为64.3%和36.6%)。高血压、糖尿病或冠心病患者使用降脂疗法的持续率显著更高。在新泽西州，多变量分析表明，在调整了可能的混杂因素后，最贫穷的患者(参加医疗补助的患者)的药物使用率低于不那么贫困的患者(参加老年人和残疾人药房援助的患者)，尽管这两个计划几乎都覆盖了药物。当在研究年度之后的5年中测量美国人群的使用率时，最初服用降脂药物的存活患者中只有52%的人仍然在填写这一药物类别的处方。结论-在所有研究的人群中，平均而言，在研究年度的三分之一以上的时间里，服用降脂药物方案的患者仍然没有填写处方。尽管处方药费用普遍覆盖，但持久率因处方药物的选择、合并症和社会经济状况而有很大不同。5年后，美国幸存的原始队列中约有一半完全停止使用降脂疗法。
Context.-Although clinical trials have demonstrated the benefits of lipid-lowering therapy, little is known about how these drugs are prescribed or used in the general population.Objective.-To estimate predictors of persistence with therapy for lipid-lowering drug regimens in typical populations of patients in the United States and Canada.Design.-A cohort study defining all prescriptions filled for lipid-lowering drugs during 1 year, as well as patients' demographic and clinical characteristics.Setting.-New Jersey's Medicaid and Pharmacy Assistance for the Aged and Disabled programs and Quebec's provincial medical care program.Patients.-All continuously enrolled patients older than 65 years who filled 1 or more prescriptions for lipid-lowering drugs (N = 5611 in the US programs, and N = 1676 drawn from a 10% sample in Quebec).Main Outcome Measures.-Proportion of days during the study year for which patients had filled prescriptions for lipid-lowering drugs; predictors of good vs poor persistence with therapy.Results.-In both populations, patients failed to fill prescriptions for lipid-lowering drugs for about 40% of the study year. Persistence rates with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors were significantly higher than those seen with cholestyramine (64.3% vs 36.6% of days with drug available, respectively). Patients with hypertension, diabetes, or coronary artery disease had significantly higher rates of persistence with lipid-lowering regimens. In New Jersey, multivariable analysis indicated that the poorest patients (those enrolled in Medicaid) had lower rates of drug use than less indigent patients (those enrolled in Pharmacy Assistance for the Aged and Disabled) after adjusting for possible confounders, despite virtually complete drug coverage in both programs. When rates of use were measured in the US population for the 5 years following the study year, only 52% of surviving patients who were initially prescribed lipid-lowering drugs were still filling prescriptions for this drug class.Conclusion.-In all populations studied, patients who were prescribed lipid-lowering drug regimens remained without filled prescriptions for over a third of the study year on average. Rates of persistence varied substantially with choice of agent prescribed, comorbidity, and socioeconomic status, despite universal coverage of prescription drug costs. After 5 years, about half of the surviving original cohort in the United States had stopped using lipid-lowering therapy altogether.