Secondary prevention of peripheral arterial disease (PAD) includes administration of antiplatelet agents, and adherence to medication is a requirement for an effective treatment. The aim of this study was to analyse adherence measured using the proportion of days covered (PDC) index separately in persistent and non-persistent patients, and to identify patient- and medication-related characteristics associated with non-adherence in these patient groups. The study cohort of 9178 patients aged ≥ 65 years in whom PAD was diagnosed in 1/-12/2012 included 6146 persistent and 3032 non-persistent patients. Non-adherence was identified as PDC < 80%. Characteristics associated with non-adherence were determined using the binary logistic regression model. In the group of persistent patients, 15.3% of subjects were identified as non-adherent, while among non-persistent patients, 26.9% of subjects were non-adherent to antiplatelet medication. Administration of dual antiplatelet therapy (aspirin and clopidogrel) and a general practitioner as index prescriber were associated with adherence in both patient groups. Our study revealed a relatively high proportion of adherent patients not only in the group of persistent patients but also in the group of non-persistent patients before discontinuation. These results indicate that most non-persistent PAD patients discontinue antiplatelet treatment rapidly after a certain period of adherence.
- Publikační typ
- časopisecké články MeSH
The effectiveness of statins in secondary prevention of peripheral arterial disease (PAD) largely depends on patients' adherence to treatment. The aims of our study were: (a) to analyze non-adherence during the whole follow-up in persistent patients, and only during persistence for non-persistent patients; (b) to identify factors associated with non-adherence separately among persistent and non-persistent patients. A cohort of 8330 statin users aged ≥65 years, in whom PAD was newly diagnosed between January 2012-December 2012, included 5353 patients persistent with statin treatment, and 2977 subjects who became non-persistent during the 5-year follow-up. Non-adherence was defined using the proportion of days covered <80%. Patient- and statin-related characteristics associated with non-adherence were identified with binary logistic regression. A significantly higher proportion of non-adherent patients was found among non-persistent patients compared to persistent subjects (43.6% vs. 29.6%; p < 0.001). Associated with non-adherence in both persistent and non-persistent patients was high intensity statin treatment, while in non-persistent patients, it was employment and increasing number of medications. In patients with a poor adherence during their persistent period, an increased risk for discontinuation may be expected. However, there is also non-adherence among persistent patients. There are differences in factors associated with non-adherence depending on patients' persistence.
- Publikační typ
- časopisecké články MeSH
Aktuálnosť problému zabezpečenia zdravotnej starostlivosti o dlhodobo chorých v súčasnosti narastá nielen na Slovensku, ale i v ďalších krajinách Európskej únie. Niektorí pacienti s ochoreniami dýchacích ciest sa často, po zvládnutí akútneho štádia, dostávajú do starostlivosti sestier v ambulantných zdravotníckych zariadeniach – agentúr domácej ošetrovateľskej starostlivosti, mobilných hospicov, ale i ústavných zdravotníckych zariadení – Domov ošetrovateľskej starostlivosti i do starostlivosti zariadení sociálnych služieb, kde je im poskytovaná ošetrovateľská starostlivosť priamo hradená z prostriedkov verejného zdravotného poistenia na základe zmluvy so zdravotnou poisťovňou. Analýzy VšZP poukazujú na pomerne stabilný až mierne stúpajúci počet a náklady na výkony ošetrovateľskej starostlivosti o dýchacie cesty u poistencov VšZP na Slovensku, u ktorých je poskytovaná ošetrovateľská starostlivosť prostredníctvom ADOS a mobilných hospicov. Činnosť sestier v rámci týchto výkonov je jasne definovaná a na Slovensku sa otvárajú i nové možnosti uzatvárania zmlúv medzi zdravotnou poisťovňou a zariadeniami sociálnych služieb.
The currentness of the problems in providing health care of chronically ill patients is on the increase not only in Slovakia, but in other European Union countries as well. Some patients with diseases of respiratory pathways, after managing the acute stage, arrive at the care of nurses in outpatient medical institutions – agencies of home nursing care, mobile hospices as well as institutional health care institutions – Homes of nursing care and also the care provided by social services institutions, where the nursing care is directly reimbursed from the resources of public medical insurance, based on the contract with a medical insurance company. Analyses of General Medical Insurance Company refer to rather stable or mildly increasing number and cost of the intervention in the nursing care of respiratory tract in policyholders of the Company in Slovakia, where the nursing care is provided by ADOS and mobile hospices. The care of nurses within these interventions is clearly defined and new possibilities are emerging in Slovakia to make contracts between medical insurance companies and social care institutions.
BACKGROUND AND OBJECTIVE: Non-persistence with secondary preventive measures, including medications such as statins, adversely affects the prospects of successful outcomes. This study was aimed at evaluating non-persistence with statin therapy in cohorts of young and elderly patients after a transient ischaemic attack (TIA) and identifying patient-associated characteristics that influence the risk for non-persistence. METHODS: The study cohorts included 797 adult patients who were initiated on statin therapy following a TIA diagnosis between 1 January 2010 and 31 December 2010. Patients were followed up for 3 years and those with a treatment gap of at least a 6-month period were considered 'non-persistent'. In order to identify any age-related differences, all analyses were conducted in the entire study cohort (n = 797) as well as separately in the 'younger' (aged <65 years, n = 267) and the 'older' (aged ≥65 years, n = 530) patients. RESULTS: Non-persistence was significantly more common in younger patients compared to older patients (67.8% vs. 49.1%; p < 0.001). Factors that decreased the probability of non-persistence in younger and older patients included diabetes mellitus (hazard ratio [HR] = 0.72 and HR = 0.64, respectively) and hypercholesterolaemia (HR = 0.43 and HR = 0.62, respectively). Female gender (HR = 1.42) was associated with a higher and increasing number of medications taken (HR = 0.93), with lower probability for non-persistence in younger patients but not in the older patients. CONCLUSIONS: Our results indicate that certain patients with TIA require special counselling to improve persistence with statin therapy. These include younger patients, especially females and those not on polypharmacy, and both younger and older patients without diabetes mellitus or hypercholesterolaemia.
- MeSH
- adherence k farmakoterapii * MeSH
- diabetes mellitus epidemiologie MeSH
- hypercholesterolemie farmakoterapie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- polypharmacy MeSH
- proporcionální rizikové modely MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statiny terapeutické užití MeSH
- tranzitorní ischemická ataka farmakoterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Klíčová slova
- KINEDRYL,
- MeSH
- antiemetika farmakologie chemie škodlivé účinky MeSH
- dítě MeSH
- dospělí MeSH
- informační služby o lécích MeSH
- kinetózy etiologie farmakoterapie prevence a kontrola MeSH
- lidé MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- MeSH
- lithiumkarbonát MeSH
- Publikační typ
- bibliografie MeSH
