骨质疏松症患者药物依从性及影响因素分析

摘要

目的：掌握骨质疏松症患者药物依从性及其影响因素。方法利用2008－2011年天津市城镇职工基本医疗保险参保人的30％抽样人群，筛选出在2009－2010年服用过双膦酸盐的骨质疏松症确诊患者，以患者首次服药的时间为研究开始时间。排除首次服药前12个月内有过服药记录的患者、首次服药时年龄小于45岁、首次诊断为骨折诊断、研究期间患有肿瘤和Paget’ s骨病的患者，并要求患者在首次服药前12个月和后12个月均持续参保。研究开始前12个月为基线期，后12个月为随访期。以药物持有率（ Medication Possession Ratio， MPR）量化患者在随访期内的药物依从性。描述患者在研究开始后3个月、6个月和12个月内的MPR，并统计不同MPR的患者人数和百分比；建立多元线性回归模型，控制患者的基线特征，以患者在研究开始后12个月内的MPR为因变量，分析影响药物依从性的可能因素。结果本研究共纳入患者2200例，其中，65．0％（N＝1430）为女性，84．2％（N＝1852）的患者已经退休，患者入组时的平均年龄为64．1（64．1±10．5）岁。随访期内患者的MPR随着时间的推移不断降低，研究开始后3个月、6个月、12个月内的患者MPR均值分别为0．34（±0．29）、0．22（±0．24）、0．15（±0．19）；12个月的随访期内只有2．1％（N＝46）的患者MPR大于0．8。多元线性回归结果显示，基线接受过骨质疏松药物治疗与MPR呈正相关，患有心脏病与MPR呈负相关。结论骨质疏松症患者的药物依从性较差，患有其他慢性病会影响患者骨质疏松治疗时的药物依从性。%Objective To estimate the adherence and its associated factors among osteoporosis patients.Methods Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) database (2008-2011) with 30%random selection, in order to select the osteoporosis patients who had used bisphosphonate from 2009 to 2010.The study started at the first time when the patients took medicine.The exclusion criteria included patients who had medication history in the past 12 months before the first medication of bisphosphonate, patients who were younger than 45 years old at the first medication, patients who were first diagnosed as fractures, patients who had tumors during the study, and patients who had Paget’ s bone diseases.A 24-month participation in medical insurance (12 months before and after the first medication, respectively) was also required.The first 12 months before the study were set as baseline.And the 12 months after the medication was set as follow-up period.Adherence was measured with a medication possession ratio (MPR).And the MPR was collected at the 3rd month, the 6th month, and the 12th month.The patient number and percentage with different MPR was calculated.Multivariate regression analysis was conducted to assess the correlation coefficient with 95%confidence intervals ( 95% CI ) of potential confounding factors.Results A total of 2200 patients with osteoporosis were enrolled.Among all the patients, 65.0% (N=1430) were female and 84.2% (N=1852) were retired.The average age was 64.1 (64.1 ±10.5) years old.Along with the increase of age, MPR of patients decreased.The mean MPR was 0.34 ( ±0.29), 0.22 ( ±0.24), and 0.15 ( ±0.19) at the 3rd month, the 6th month, and the 12th month during the follow-up period, respectively.Only 2.1% ( N=46 ) of patients with MPR≥0.8 were found during the 12-month follow-up.Multivariate regression results showed that patients with prior medication treatment during the baseline period had better compliance ( correlation coefficient=0.07 and 95%CI=0.03-0.10), while patients with heart diseases had poorer compliance (correlation coefficient=-0.04 and 95% CI=-0.06 -0.02 ) after adjusting for patients demographic and comorbidity characteristics.Conclusion Compliance of bisphosphonate therapy for osteoporosis patients in Tianjin is significantly poorer compared to previous research in developed countries.More attentions should be paid and policy guidance is needed to improve the medication adherence among patients with osteoporosis in China.