Determinants of use of medications for the secondary prevention of cardiovascular disease

项目目的：我的研究目的是通过估计心脏保护药物使用的次优程度，以及不同社会经济群体对干预措施的吸收变化，分析英国心血管疾病（CVD）的当前药理学管理。利用NHS苏格兰和英国生物银行的数据，该研究试图检查英国心血管疾病二级预防药物使用的最新趋势。该项目还将分析预防药物的处方率和/或使用是否会随着社会剥夺的加剧而减少，以及苏格兰取消处方收费是否对心血管药物的使用产生了影响。本研究的第二部分旨在通过研究其与高危患者接受治疗的相关性，调查患者和处方者特征在心血管药物利用不足中的作用。我的研究将建立在Achelrod等人（2016）关于2004-2013年欧洲降胆固醇和降血压药物用于二级心血管预防的研究基础上，并将研究扩展到英国。鉴于英国心血管疾病相关死亡率中日益扩大的社会经济不平等1，该研究将假设，在社会经济和生活方式风险因素方面，不接受治疗的个体与接受治疗的患者存在显著差异。一般研究问题调查使用/不使用CVD二级预防药物的CVD患者的特征。子问题检查社会经济、行为和认知因素预测药物处方、开始和坚持的程度。第三，本研究将研究在不同类别的患者中，心脏保护干预是健康行为的补充还是替代。因此，我将探讨贝克尔（2007）将健康作为人力资本的扩展理论模型的各个方面，该模型可以为健康行为和预防性药物使用之间的估计相互作用提供信息。一般的研究问题是：当开始心脏预防治疗时，个人会改变他们的健康行为吗？研究的重要性本研究通过使用最新数据对英国心血管药物用于心血管疾病二级预防的现状和决定因素进行首次深入分析，解决了文献中的一些空白，并将研究结果与其他欧洲国家发表的研究结果进行了比较。因此，这项研究将为目前预防心血管疾病的障碍和次优用药的危险因素提供重要的见解。鉴于心血管疾病的高负担和高成本，研究结果将支持新的有效的治疗改善和生活方式管理政策。[参考文献]Bajekal et al., PLoS One 8(3),（2013）。

PROJECT AIMSThe aim of my research is to analyse the current pharmacological management of cardiovascular disease (CVD) in the UK by estimating the degree of suboptimal cardioprotective drug use, as well as the variations in the uptake of interventions across socio-economic groups. Using NHS Scotland and UK Biobank data, the research seeks to examine recent trends in drug use for the secondary prevention of CVD in the UK. The project will also analyse whether the prescription rate and/or usage of preventive drugs decreases with greater social deprivation, and whether the abolition of prescription charges in Scotland has had an impact on cardiovascular medication use. The second part of this study seeks to investigate the role of patient and prescriber characteristics in the underutilisation of cardiovascular medications by studying their relevance to the uptake of treatment in high-risk patients. My research will build on Achelrod and et al.'s (2016) study on Cholesterol- and blood-pressure-lowering drug use for secondary cardiovascular prevention in 2004-2013 Europe, extending research to the UK. In view of the widening socio-economic inequalities in CVD-related mortality in the UK1, the study will hypothesise that individuals who do not take up treatment will significantly differ from treated patients in terms of socio-economic and lifestyle risk factors. The general research question investigates the characteristics of individuals with CVD, who use/do not use drugs for the secondary prevention of CVD. Sub-questions examine the extent to which socio-economic, behavioural and cognitive factors predict medication prescription, initiation and adherence. Third, the research will study whether cardioprotective interventions are compliments or substitutes of health behaviours in different categories of patients. As such, I will explore aspects of Becker's (2007) extended theoretical model of health as human capital that could inform the estimated interaction between health behaviours and preventive drug use. The general research question addressed is: do individuals change their health behaviours when initiating cardiopreventive treatment?IMPORTANCE OF RESEARCH This research addresses a number of gaps in literature by using recent data to conduct the first in-depth analysis on the current situation and determinants of cardiovascular medication use for the secondary prevention of CVD in the UK and to compare the findings with published work from other European countries. As such, this study will provide significant insight on the current barriers to CVD prevention and risk factors of suboptimal drug use. The findings will support novel effective policies for treatment amelioration and lifestyle management that are urgently needed given the high burden and costs of CVD. REFERENCES [1] Bajekal et al., PLoS One 8(3), (2013).