老年高血压患者自我感知老化对服药依从性的影响

目的 探讨老年高血压患者自我感知老化对服药依从性的影响.方法 对苏州市350例社区老年高血压患者进行问卷调查,采用Morisky服药依从性量表评估服药依从性,分析自我感知老化总分及其8个维度得分对服药依从性的影响.结果 350例中,服药依从性不良(＜6分)者222例(63.4％).服药依从性良好(≥6分)组自我感知老化总分低于不良组[(80.10±39.03)分vs.(91.64±28.83)分](P＜0.01).周期时间性维度、情感表征维度、积极控制维度、消极控制维度、积极结果维度及认同维度的高、中、低不同得分组之间患者服药依从性也有明显差异(P＜0.05).血压控制良好、积极控制维度与积极结果维度高得分是患者服药依从性的保护因素,周期时间性维度高得分与认同维度中、高得分是其危险因素.结论 老年高血压患者的服药依从性水平较低,自我感知老化是影响其服药依从性的重要因素.     

Effectiveness of a two-part educational intervention to improve hypertension control: a cluster-randomized trial

STUDY OBJECTIVE: To measure the effectiveness of a multifaceted educational intervention to improve ambulatory hypertension control. DESIGN: Cluster-randomized trial. SETTING: Academic health system using an ambulatory electronic medical record. SUBJECTS: A total of 10,696 patients with a diagnosis of hypertension cared for by 93 primary care providers. INTERVENTION: Academic detailing, provision of provider-specific data about hypertension control, provision of educational materials to the provider, and provision of educational and motivational materials to patients. MEASUREMENTS AND MAIN RESULTS: The primary outcome was blood pressure control, defined as a blood pressure measurement below 140/90 mm Hg, and was ascertained from electronic medical records over 6 months of follow-up. We determined the adjusted odds ratio for the association between the intervention and the achievement of controlled blood pressure. When we accounted for clustering by provider, this adjusted odds ratio was 1.13 (95% confidence interval 0.87-1.47). Adjusted odds ratios were 1.03 (95% confidence interval 0.78-1.36) in patients whose blood pressure was controlled at baseline and 1.25 (95% confidence interval 0.94-1.65) in those whose blood pressure was not. These odds ratios were not significantly different (p=0.11). CONCLUSIONS: These results were consistent with no effect or, at best, a relatively modest effect of the intervention among patients with hypertension. Had we not included a concurrent control group, the data would have provided an unduly optimistic view of the effectiveness of the program. The effectiveness of future interventions may be improved by focusing on patients whose blood pressure is uncontrolled at baseline.     

Structured pharmacist-led intervention programme to improve medication adherence in COPD patients: A randomized controlled study

Background

COPD is characterised by a progressive airflow limitation in the lungs. However, adherence to therapy improves management of symptoms and delays disease progression. Therefore, patients' knowledge and awareness about the disease are important. Hence, pharmacist-led educational interventions could achieve this and improve medication adherence.

Environmental and individual predictors of medication adherence among elderly patients with hypertension and chronic kidney disease: A geospatial approach

BackgroundFew studies have examined how adherence to antihypertensive medications varies across different regions or how neighborhood-level factors were related to individuals’ medication-taking behaviors in patients.ObjectiveTo explore local variation in medication adherence and examine environmental and individual influences on adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) among elderly hypertensive patients with chronic kidney disease (CKD) in the United States.MethodsThe Medicare 5% sample claim data (2006-2013), American Community Survey 5-Year Data (2005-2009) and the Health Resources and Services Administration Primary Care Service Area data (2007). The primary outcome was medication adherence, measured by Proportion of Days Covered (PDC). Geographically weighted regression (GWR) and linear mixed-effects models were used to investigate the relationship between environmental factors, individual risk factors and medication adherence.ResultsA total of 70,201 hypertensive CKD patients residing in 2,981 counties of the US were selected. Significant spatial autocorrelation was observed in ACEIs/ARBs PDC. The West North Central and New England regions demonstrated higher adherence compared to the East South Central and West South Central regions. Residing in Medically Underserved Areas, counties with high deprivation scores, and not receiving Part D Low-income Subsidy were associated with poor medication adherence.ConclusionsMedication adherence is geographically differentiated across the US. Environmental and individual factors identified may be helpful in the design of local interventions focused on improving patient outcomes from a population perspective.     

高血压患者社区药物治疗的影响因素探讨

目的 探讨社区高血压患者坚持服药治疗的影响因素。方法 2001年9月至2005年4月，以新桂社区已确诊并建立档案的882名原发性高血压患者进行服药情况及相关因素调查和血压测量，对各相关因素进行服药依从性影响因素分析。结果 高血压患者服药依从率为21．43％。影响服药依从性的因素有性别、年龄、文化程度、家庭经济、亲友病史、高血压常识、血压升高程度、药物不良反应、药费贵。结论 高血压患者坚持服药的影响因素多样，提高服药率的关键是采用有针对性的个性化措施。     

A successful intervention to improve medication adherence in Black patients with hypertension: Mediation analysis of 28-site TEAM trial

BackgroundWe previously reported the main effects and cost-effectiveness of a successful multifaceted Team Education and Adherence Monitoring (TEAM) intervention to improve refill adherence in Black patients with hypertension. It is important to identify the key mediators or intervention components that contributed to this intervention effect.ObjectivesThis study aimed to conduct a “mediation analysis” to determine which intervention components had the largest effect on refill adherence and assess patient satisfaction with pharmacy care.MethodsA cluster-randomized trial was conducted among 576 Black patients in 28 pharmacies (14 TEAM, 14 control). TEAM participants were invited to 6 visits with a pharmacist-technician team that monitored the patient’s blood pressure and used a 9-item Brief Medication Questionnaire, Brief Goal Check, and other novel tools to identify and reduce barriers to adherence in Black patients. Control participants received printed information only. Refill adherence was defined as >80% days covered (proportion of days covered) per refill records during months 7 to 12 (postintervention); potential mediators and patient satisfaction were assessed using a research questionnaire administered at month 6. A structural probit model examined 4 potential mediators that might explain intervention success.ResultsOf 4 potential mediators, the most important factors in explaining the improvement in refill adherence (postintervention) were greater pharmacist collaboration with patient in barrier reduction (68.5% of total indirect effect) and patient use of a pillbox (27.2% of total indirect effect). Pharmacist contact with physician and suggestion of a change in regimen did not have significant effects on adherence. TEAM participants were more likely than control participants to rate their pharmacist care as “very satisfactory” (80.2% vs. 44.2%, P < 0.001) and technician care as “very satisfactory” (81.2% vs. 47.4%, P < 0.001).ConclusionRefill adherence and satisfaction can be improved in Black patients with hypertension by implementing a collaborative TEAM model with novel tools that enable community pharmacists and technicians to help identify and reduce the core barriers to adherence. Our results can be used to individualize and improve patient care and adherence outcomes in this vulnerable population.     

北京地区高血压患者用药依从性及影响因素调查与研究

目的：调查北京地区高血压患者药物治疗依从性及达标率现状,分析依从性的主要影响因素和药师提供药学服务后患者依从性的改善情况,以期为后续制定社区药学服务干预措施提供数据支持。方法：设计依从性及影响因素调查问卷,药师通过面对面访谈的形式开展前瞻性调研并提供药学服务,跟踪随访3个月,比较依从性变化。结果：共调研高血压患者1382人,药学服务前后依从性差的患者例数为447（32.34%）和356（25.76%）,两者比较有统计学差异（P<0.05）;多因素Logistics回归显示年龄、吸烟、饮酒、自行经验购药、体育锻炼和生活方式是依从性的独立影响因素（P<0.05）。结论：我国高血压患者的药物治疗依从性现状仍然不太理想,药学服务能显著提高患者的用药依从性。针对依从性危险因素,今后药学干预措施应侧重于高血压用药知识宣教、加强体育锻炼、戒烟宣传及健康生活方式指导。     

Patient-specific factors relating to medication adherence in a post-percutaneous coronary intervention cohort

Objective To explore the association between medication adherence and qualitatively characterised patient‐specific themes relating to medication adherence in patients following percutaneous coronary intervention (PCI). Methods Data‐collection questionnaires and qualitative topic guides were piloted in two patients. A validated questionnaire generated an adherence score for a convenience sample of 20 patients within 7 days of PCI. Semi‐structured qualitative interviews were subsequently carried out with all patients to explore patient‐specific themes relating to measured medication adherence. Key findings Fourteen out of 20 patients (70%) had scores indicative of good adherence. Key factors associated with good adherence included having a good relationship with the doctor, having an understanding of the condition, knowledge of the indications and consequences of non‐adherence, perceived health benefits and medications eliciting tangible symptom control. There were misconceptions of concern regarding adverse drug reactions and the importance of aspirin, both of which had a negative effect on adherence. The role of the community pharmacist was sometimes, although not always, misunderstood. Conclusion This study suggests there is an association between patients' beliefs, knowledge, understanding and misconceptions about medication and their adherence in a post‐PCI cohort. To optimise medication adherence it is vital for prescribers to remain patient‐focused and cognisant of patient‐specific themes relating to medication adherence.     

Factors associated with medication adherence and persistence of treatment for hypertension in a Medicaid population

BackgroundNon-adherence with antihypertensive therapy is a significant problem. Prior research has generally focused upon one drug or one drug class. Current information across multiple antihypertensive drug classes is limited.ObjectivesTo describe the initial treatment of recipients of Louisiana Medicaid with newly-diagnosed hypertension; evaluate differences in adherence and persistence rates among multiple antihypertensive drug classes; and test the association of drug classes, race, gender, age and comorbidity with adherence and persistence to drug therapy.MethodsIn a retrospective analysis of administrative claims data, initial therapy was described by type and drug class for 4544 Medicaid recipients with newly-diagnosed hypertension. Recipients were placed into cohorts based upon drug classes (diuretics, beta-blockers, angiotensin-II receptor blockers, angiotensin converting enzyme inhibitors, and calcium channel blockers). Persistence with drug therapy and Medication Possession Ratios (MPR) were calculated for 6-month and 12-month periods following diagnosis. Drug class and demographic variables were used as predictor variables in logistic regression analyses of persistence and MPR.ResultsRecipients in the study group were primarily female (66%) and Black (65%). Recipients initially were treated with monotherapy (33%), multiple drugs (11%), fixed combinations (8%) or no drugs (48%). After one year, 62% of recipients were not receiving drug therapy. Persistence rates by cohort ranged from 26% to 42% at 6-months following diagnosis, and 14%–28% at 12-months. The proportion of recipients by cohort with MPRs of 0.8 or above ranged from 43% to 60% at 6-months and 25%–42% at 12-months. Race, comorbidities, and initial drug therapy were significant predictors of both persistence and MPR.ConclusionsWithin this study group, adherence and persistence to medication therapy were less than optimal. Future efforts to improve compliance with medication therapy could be focused upon specific groups having poor adherence and/or persistence within the drug class cohorts analyzed in this study.     

药学服务对原发性高血压病人用药依从性的影响

目的：研究药学服务对原发性高血压病人用药依从性的影响。方法：60例病人随机分为药学服务干预组和对照组。采用病人用药依从性记录卡,对60例病人随访前后的用药依从性进行记录,评价每例病人用药的剂量依从性和时间依从性。结果：经过3个月的随访,与对照组相比,药学服务干预组病人的用药剂量依从性和时间依从性明显提高,而对照组实验前后没有变化。结论：药学服务可以明显提高病人的用药依从性。