Chronic Disease Management to Enhance Medication Adherence Trajectories in Long-Term Survivors of Stroke: A Population-Based Cohort Study.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY

Pharmacoepidemiology and Drug Safety Pub Date : 2025-05-01 DOI:10.1002/pds.70148

Lachlan L Dalli, Monique F Kilkenny, Muideen T Olaiya, David Ung, Joosup Kim, Leonid Churilov, Dominique A Cadilhac, Vijaya Sundararajan, Amanda G Thrift, Mark R Nelson, Natasha A Lannin, Rebecca Barnden, Velandai Srikanth, Nadine E Andrew

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引用次数: 0

Abstract

Purpose: Although chronic disease management (CDM) has been reported to improve medication adherence after stroke or transient ischaemic attack (TIA), the impact on specific patterns of medication adherence is unclear. We aimed to evaluate the population effect of receiving a CDM claim on trajectories of medication adherence in long-term survivors of stroke/TIA.

Methods: A cohort study was undertaken using observational data from PRECISE (42 Australian Stroke Clinical Registry hospitals [Victoria and Queensland; 2012-2015] linked with medication dispensing and primary care claims). Community-dwelling adults with ≥ 1 primary care visit were included. The exposure was a CDM claim (versus no claim) in primary care within 7-18 months post-stroke/TIA. Medication adherence (antihypertensive, antithrombotic, lipid-lowering) was assessed between 19 and 30 months post-stroke/TIA, using group-based trajectory models. Average treatment effects were estimated using multi-level logistic regression with inverse probability treatment weights.

Results: Among 11 580 survivors of stroke/TIA (median age 70 years, 42% female; 45% with CDM claim), four distinct adherence patterns were identified: near-perfect adherence, high adherence, declining adherence, and non-use. After adjustment, having a CDM claim (vs no claim) promoted near-perfect adherence (odds ratio [OR]: 1.16 [95% CI 1.08-1.25]) for antithrombotic medications. Whereas, having a CDM claim (vs no CDM claim) promoted high adherence for antihypertensive (OR: 1.33 [95% CI 1.24-1.44]) or lipid-lowering (OR: 1.26 [95% CI 1.16-1.37]) medications. The odds of non-use were also reduced by 17%-23% in those with (vs without) a CDM claim.

Conclusions: CDM claims were associated with favourable trajectories of medication adherence in long-term survivors of stroke/TIA.

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慢性疾病管理提高中风长期幸存者的药物依从性轨迹：一项基于人群的队列研究

目的：虽然有报道称慢性疾病管理（CDM）可以改善中风或短暂性缺血发作（TIA）后的药物依从性，但对特定模式的药物依从性的影响尚不清楚。我们的目的是评估接受CDM索赔对卒中/TIA长期幸存者药物依从性轨迹的总体影响。方法：采用一项队列研究，使用来自42家澳大利亚卒中临床登记医院[维多利亚和昆士兰；（2012-2015）与药物配药和初级保健索赔相关)。≥1次初级保健就诊的社区居住成年人被纳入研究。卒中/TIA后7-18个月的初级保健中，暴露是CDM索赔（相对于无索赔）。使用基于组的轨迹模型，评估卒中/TIA后19至30个月的药物依从性（降压、抗血栓、降脂）。平均处理效果估计采用多层级逻辑回归与反概率处理权。结果：在11 580例脑卒中/TIA幸存者中(中位年龄70岁，42%为女性；45% （CDM声称），确定了四种不同的依从性模式：接近完美的依从性、高依从性、下降依从性和不使用。调整后，有CDM声明（vs无声明）促进了抗血栓药物近乎完美的依从性（优势比[OR]: 1.16 [95% CI 1.08-1.25]）。然而，有CDM声明（与没有CDM声明相比）促进了降压药物的高依从性（OR: 1.33 [95% CI 1.24-1.44]）或降脂药物（OR: 1.26 [95% CI 1.16-1.37]）。那些有CDM声明的患者（与没有CDM声明的患者相比）不使用CDM的几率也降低了17%-23%。结论：CDM主张与卒中/TIA长期幸存者良好的药物依从性轨迹相关。

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.