Cohort Study of Medication Adherence Among Older Adults

描述(由申请人提供)：至少有5000万美国成年人患有高血压，这是冠心病、中风和终末期肾脏疾病的一个重要的可改变的危险因素。有效的降压药物是可用的，但老年人对药物的低依从性可能导致糟糕的结果。拟议的前瞻性队列研究的总体目标是确定与老年人(=65岁)抗高血压药物依从性降低相关的因素。要调查的因素包括心理社会、行为、生活质量(QOL)、医疗保健系统问题(包括共同支付/福利)、知识、性功能(SF)、用药类别、非传统治疗/生活方式调整的使用情况以及临床因素。将全面评估这些因素的影响，并按性别和种族进行评估。我们建议在一家管理性医疗机构(MCO)对2,000名65岁的确诊为原发性高血压(HTN)的患者进行前瞻性队列研究。这项研究旨在具有80%的统计能力，以检测在人口统计学、行为、临床和治疗因素相关的2年跟踪调查中，基线服药依从性低于1.5的相对风险，以及从高到中或中等到低依从性过渡到低于2.0的相对风险。将从所有符合条件的参与者中随机抽取一组年龄为65岁的HTN患者按种族和性别分层，参加南方一家大型MCO的医疗保险风险产品。患者将被前瞻性地跟踪平均两年，服药依从性、生活质量、SF、人口、治疗、社会经济、知识、临床和行为因素将在基线和年度电话管理的跟踪调查中确定。基线和随访时的图表提取将用于评估血压控制、心血管结果和HTN严重程度。MCO计算机化医疗记录系统将用于访问HTN药物、心血管结果、共同支付/收益和利用的数据。主要结果将是基线用药依从性和随访期间用药依从性的变化。此外，还将检查基线用药依从性对血压控制、生活质量、利用率和随访期间心血管结果的影响。这项研究的结果将为干预措施改善老年高血压患者的用药依从性和临床结果奠定基础，并将增加我们对这些患者使用药物的治疗结果的影响因素的了解。

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.