Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults.
Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults.
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DOI：
10.1161/hypertensionaha.111.176859
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发表时间：
2011-11
期刊：
影响因子：
--
通讯作者：
Re RN
中科院分区：
文献类型：
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作者：
Krousel-Wood M;Joyce C;Holt E;Muntner P;Webber LS;Morisky DE;Frohlich ED;Re RN
关于降压药依从性下降的预测因素以及依从性下降与随后的血压(BP)控制之间的关联的数据很少。目前的分析包括2006年8月至2007年9月期间招募的1,965名成年人，他们来自老年人服药依从性队列研究(COSMO)。抗高血压药物依从性的下降被定义为在基线后1年和2年的电话调查中评估的8项莫里斯基药物依从性量表中≥2分的下降。使用电话调查和行政数据库收集了遵从性下降的风险因素。BP是从门诊记录中提取出来的。依从性下降的年率为4.3%(159名参与者经历了下降)。在多变量调整后，依从性的下降与随访时未控制的BP(≥140/90 mm Hg)的优势比(OR)有关(95%CI：1.01，2.80)。抑郁症状(OR 1.84，95%CI 1.20，2.82)和高应激性生活事件评分(OR 1.68，95%CI 1.19，2.38)与服药依从性下降的OR值高相关。女性(OR 0.61，95%CI 0.42，0.88)、已婚(OR 0.68，95%CI 0.47，0.98)和钙通道阻滞剂的使用(OR 0.68，95%CI 0.48，0.97)与降低OR值有关。总而言之，抗高血压药物依从性的下降与血压失控有关。确定了与下降相关的可修改因素。有必要进行进一步的研究，以确定干预措施是否可以防止降压药物依从性的下降，并改善血压控制。
Few data are available on the predictors of decline in antihypertensive medication adherence and the association of decline in adherence with subsequent blood pressure (BP) control. The current analysis included 1,965 adults from the Cohort Study of Medication Adherence among Older Adults (CoSMO) recruited between August 2006 and September 2007. Decline in antihypertensive medication adherence was defined as a ≥ 2 point decrease on the 8-item Morisky Medication Adherence Scale assessed during telephone surveys 1 and 2 years following baseline. Risk factors for decline in adherence were collected using telephone surveys and administrative databases. BP was abstracted from outpatient records. The annual rate for a decline in adherence was 4.3% (159 participants experienced a decline). After multivariable adjustment, a decline in adherence was associated with an odds ratio (OR) for uncontrolled BP (≥140/90 mm Hg) at follow up of 1.68 (95% CI: 1.01, 2.80). Depressive symptoms (OR 1.84, 95%CI 1.20, 2.82) and a high stressful life events score (OR 1.68, 95% CI 1.19, 2.38) were associated with higher ORs for a decline in adherence. Female gender (OR 0.61, 95% CI 0.42, 0.88); being married (OR 0.68, 95% CI 0.47, 0.98); and calcium channel blocker use (OR 0.68, 95% CI 0.48, 0.97) were associated with lower ORs for decline. In summary, a decline in antihypertensive medication adherence was associated with uncontrolled BP. Modifiable factors associated with decline were identified. Further research is warranted to determine if interventions can prevent the decline in antihypertensive medication adherence and improve BP control.