全国114家医疗机构青光眼患者用药依从性分析

Drug adherence of glaucoma patients at 114 Chinese hospitals

目的:评估中国青光眼患者对抗青光眼药物的用药依从性,并确定其相关因素。方法:采用全军合理用药监测网处方数据(2015—2017)。纳入2016年1月至2016年12月期间首次诊断为青光眼或高眼压症且在首次诊断日期前12个月(基线期)和后12个月(随访期)都在持续参保的成人患者。药物持有比例>80%的患者和没有120 d的抗青光眼药物治疗间隔被认定为依从性良好。结果:共纳入8593位青光眼患者,平均年龄为50.14岁,50.1%为女性。双眼患病患者占比为72%。患者的药物持有率均值为(0.167±0.11),持续用药时间均值为(61.48±46.47)d。本研究显示用药频率和患眼只数与用药依从性相关。与用药频率大于每日2次的患者相比,用药频率小于等于每日2次的患者可能有更高的药物持有率[校正OR(95%CI):3.51(1.39~8.84),P=0.008]和更长的持续用药时间[校正HR(95%CI):0.86(0.81~0.92),P=0.001]。单眼患病组较双眼患者组可能倾向于更低的药物持有率[校正OR(95%CI):0.10(0.02~0.42),P=0.001]和更长的持续用药时间[校正HR(95%CI):0.340(0.32~0.36),P<0.001]。结论:初次诊断的青光眼患者用药依从性普遍较低,临床可适当增加用药频次低的滴眼剂的使用比例,以增强青光眼患者的用药依从性。

OBJECTIVE To evaluate the adherence of glaucoma drugs in Chinese glaucoma patients and determine the related factors.METHODS The prescription data of PLA Rational Drug Use Monitoring Network(2015-2017)were extracted.The subjects were adult patients initially diagnosed as glaucoma or ocular hypertension between January 2016 and December 2016.They were continuously insured for 12 months before an initial diagnosis(baseline)and 12 months after(follow-ups).Adherence was judged as good in patients with medication possession ratio>80%(MPR)and without a 120-day interval between medications for glaucoma.RESULTS A total of 8593 glaucoma patients were recruited with a mean age of 50.14 years(50.1%females).Those with binocular disease accounted for 72%.The mean rate of drug possession was(0.167±0.11)and the mean duration of drug use(61.48±46.47)days.Medication frequency and number of eyes were associated with adherence.As compared with counterparts more frequently than twice daily,users less frequently than twice daily were likely to have a higher rate of drug possession[adjusted OR(95%CI):3.51(1.39-8.84),P=0.008]and longer duration of medication[adjusted HR(95%CI):0.86(0.81-0.92),P=0.001].The monocular group had a lower rate of drug possession[adjusted OR(95%CI):0.10(0.02-0.42),P=0.001]and duration of medication[adjusted HR(95%CI):0.340(0.32-0.36),P<0.001]than binocular group.CONCLUSION The adherence of glaucoma patients with an initial diagnosis is generally low.And the proportion of eyedrops with low medication frequency may be appropriately boosted for enhancing their adherence.