Cohort Study of Medication Adherence Among Older Adults

描述（由申请人提供）：至少有5000万成年美国人患有高血压，这是冠心病、中风和终末期肾病的一个重要的可改变的风险因素。有效的降压药物是可行的，但老年人对药物的低依从性可能导致不良结局。本前瞻性队列研究的总体目标是确定与老年人（≥ 65岁）降压药物依从性降低相关的因素。待调查的因素包括社会心理、行为、生活质量（QOL）、医疗保健系统问题（包括共同负担/受益）、知识、性功能（SF）、药物类别、非常规治疗/生活方式改变的使用和临床因素。这些因素的影响将按性别和种族进行总体评估。我们计划在一家管理式医疗机构（MCO）中开展一项前瞻性队列研究，纳入2,000名年龄≥ 65岁的确诊原发性高血压（HTN）受试者。本研究设计为具有80%的统计学把握度，以检测基线时药物依从性小于1.5的相对风险，以及2年随访期间从高依从性转变为中等依从性或从中等依从性转变为低依从性的相对风险小于2.0（与人口统计学、行为、临床和治疗因素相关）。将从所有符合条件的参与者中选择一个随机的、种族和性别分层的HTN患者样本，这些患者年龄≥ 65岁，参加了一个大型南方MCO的医疗保险风险产品。将对患者进行平均2年的前瞻性随访，并在基线和年度电话随访调查期间确定药物依从性、QOL、SF、人口统计学、治疗、社会经济、知识、临床和行为因素。基线和随访时的图表摘要将用于评估血压控制、心血管结局和HTN严重程度。MCO计算机化病历系统将用于访问HTN药物、心血管结局、共同负担/获益和利用的数据。主要结局将是基线时的药物依从性和随访期间药物依从性的变化。此外，还将检查基线时药物依从性对随访期间血压控制、QOL、利用率和心血管结局的影响。这项研究的结果将为改善老年高血压患者的药物依从性和临床结局的干预措施奠定基础，并将增加我们对这些患者使用药物治疗结果的因素的理解。

DESCRIPTION (provided by applicant): At least 50 million adult Americans have hypertension, an important modifiable risk factor for coronary heart disease, stroke and end-stage renal disease. Efficacious blood pressure lowering medications are available but low adherence to medication by older adults can lead to poor outcomes.The overall objective of the proposed prospective cohort study is to determine factors that are associated with reduced antihypertensive medication adherence among older adults (>=65 years). The factors to be investigated include psychosocial, behavioral, quality of life (QOL), health care system issues including copayment/benefit, knowledge, sexual function (SF), medication class, use of unconventional therapies/lifestyle modifications.and clinical factors. The impact of these factors will be assessed overall and by gender and race. We propose to conduct a prospective cohort study with 2,000 participants >= 65 years of age with diagnosed essential hypertension (HTN) in a managed care organization (MCO). This study is designed to have 80% statistical power to detect relative risks of less than 1.5 of medication adherence at baseline and less than 2.0 for transitioning from high to medium or medium to low adherence over 2 years of follow-up associated with demographic, behavioral, clinical and treatment factors. A random, race-and gender- stratified sample of HTN patients >=65 years enrolled in the Medicare Risk Product of a large southern MCO will be selected from all eligible participants. Patients will be followed prospectively for an average of 2 years and medication adherence, QOL , SF, demographic, treatment, socio-economic, knowledge, clinical and behavioral factors will be determined at baseline and during annual telephone-administered follow-up surveys. Chart abstraction at baseline and follow-up will be used to assess blood pressure control, cardiovascular outcomes and HTN severity. MCO computerized medical record system will be used toaccess data on HTN medications, cardiovascular outcomes, copayment/benefit and utilization. The primary outcome will be medication adherence at baseline and changes in medication adherence during follow-up. In addition, the impact of medication adherence at baseline on blood pressure control, QOL, utilization, and cardiovascular outcomes during follow-up will be examined. Results of this study will lay the groundwork for interventions to improve medication adherence and clinical outcomes in older adults with hypertension and will increase our understanding of factors contributing to therapeutic outcomes in the use of medications by these patients.