Analysis of Longitudinal Patterns and Predictors of Medicine Use in Residential Aged Care Using Group-Based Trajectory Modeling: The "MEDTRAC-Cardiovascular" Longitudinal Cohort Study.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY

Pharmacoepidemiology and Drug Safety Pub Date : 2024-08-01 DOI:10.1002/pds.5881

Nasir Wabe, Andrea Timothy, Rachel Urwin, Ying Xu, Amy Nguyen, Johanna I Westbrook

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引用次数: 0

Abstract

Aim: Cardiovascular diseases are the leading cause of death globally. Ensuring ongoing use of medicines-medication persistence-is crucial, yet no prior studies have examined this in residential aged care facilities (RACFs). We aimed to identify long-term trajectories of persistence with cardiovascular medicines and determine predictors of persistence trajectories.

Method: A longitudinal cohort study of 2837 newly admitted permanent residents from 30 RACFs in New South Wales, Australia. We monitored weekly exposure to six cardiovascular medicine classes-lipid modifiers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs), beta-blockers, diuretics, calcium channel blockers (CCB), and cardiac therapy-over 3 years. Group-based trajectory modeling was employed to determine persistence trajectories for each class.

Results: At baseline, 76.6% (n = 2172) received at least one cardiovascular medicine with 41.2% receiving lipid modifiers, 31.4% ACEI/ARBs, 30.2% beta-blockers, 24.4% diuretics, 18.7% CCBs, and 14.8% cardiac therapy. The model identified two persistence trajectories for CCBs and three trajectories for all other classes. Sustained high persistence rates ranged from 68.4% (ACEI/ARBs) to 79.8% (beta-blockers) while early decline in persistence and subsequent discontinuation rates ranged from 7.6% (cardiac therapy) to 25.3% (CCBs). Logistic regressions identified 11 predictors of a declining persistence across the six medicine classes.

Conclusion: Our study revealed varied patterns of cardiovascular medicine use in RACFs, with 2-3 distinctive medicine use trajectories across different classes, each exhibiting a unique clinical profile, and up to a quarter of residents discontinuing a medicine class. Future studies should explore the underlying reasons and appropriateness of nonpersistence to aid in identifying areas for improvement.

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利用基于群体的轨迹模型分析住院养老护理中用药的纵向模式和预测因素：MEDTRAC-心血管 "纵向队列研究。

目的：心血管疾病是导致全球死亡的主要原因。确保持续用药--用药的持久性--至关重要，但此前还没有研究对养老机构进行过这方面的调查。我们旨在确定心血管药物的长期持续使用轨迹，并确定持续使用轨迹的预测因素：方法：对澳大利亚新南威尔士州 30 家养老院中新入住的 2837 名永久居民进行纵向队列研究。我们对每周接触六类心血管药物的情况进行了监测--血脂调节剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）、β-受体阻滞剂、利尿剂、钙通道阻滞剂（CCB）和心脏治疗--为期三年。采用基于组的轨迹模型来确定每一类药物的持续治疗轨迹：基线时，76.6%的患者（n = 2172）至少接受了一种心血管药物治疗，其中41.2%的患者接受了调脂药，31.4%的患者接受了ACEI/ARB，30.2%的患者接受了β-受体阻滞剂，24.4%的患者接受了利尿剂，18.7%的患者接受了CCB，14.8%的患者接受了心脏治疗。该模型为 CCBs 确定了两个持续率轨迹，为所有其他类别确定了三个轨迹。持续高持续率从 68.4%（ACEI/ARBs）到 79.8%（β-受体阻滞剂）不等，而早期持续率下降和随后停药率从 7.6%（心脏治疗）到 25.3%（CCBs）不等。逻辑回归确定了六类药物中 11 个预测持续率下降的因素：我们的研究揭示了 RACF 中心血管药物的不同使用模式，不同类别的药物有 2-3 种不同的使用轨迹，每种药物都表现出独特的临床特征，多达四分之一的住院医师中断了某一类别的药物。未来的研究应探讨不坚持用药的根本原因和适当性，以帮助确定需要改进的领域。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.