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首页> 外文学位 >Physician and patient influences in statin treatment adherence and associated outcomes in V.A. patients with hypercholesterolemia.
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Physician and patient influences in statin treatment adherence and associated outcomes in V.A. patients with hypercholesterolemia.

机译：医师和患者对他汀类药物治疗依从性及相关结果的影响高胆固醇血症患者。

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摘要

Clinical trials have shown that patients treated with HMG-CoA reductase inhibitors (statins) experience significant reductions in low-density lipoprotein cholesterol (LDL-C) levels and coronary heart disease (CHD) events. Suboptimal dosages of statins and the quality of statin treatment have resulted in a gap between projected statin efficacy and statin effectiveness in the clinical setting, which leads to increased CHD morbidity and costs. Previous studies have focused on patient or physician contributions to this problem. This dissertation simultaneously examines the effects of patient statin adherence and primary care physician (PCP) guideline compliance on associated health outcomes in veterans---a high-risk patient population with few barriers to medications and institutional care.;Findings demonstrate that poor adherence was a significant barrier of LDL-C goal attainment and remained significant after controlling for potential confounders of adherence. Furthermore, this dissertation illustrated that patient statin adherence levels <100% reduced the benefits of statin treatment on LDL-C management even when a patient's LDL-C goal had previously been met.;Two national guideline recommendations---physician follow-up visits and annual lipid monitoring---were found to positively influence patient statin adherence. An increase in the PCP rate for conducting annual lipid evaluations reduced the probability of a CHD event or death, especially among patients without history of heart disease. Higher levels of statin adherence were associated with a higher probability of a CHD event or death. This unexpected association may have been due to higher levels of adherence among patients with more CHD risk and the study's limited ability to deal with residual confounding due unmeasured disease severity.;Work presented in this dissertation suggests that patient statin adherence and the effectiveness of statin therapy in reducing CHD events and mortality may be improved with a combination of enhanced follow-up office visits and annual lipid evaluations by PCPs. Therefore, due to the prevalence of CHD and the aging of the population, it is important that more research be performed to align PCP practice with the national guidelines and to improve patient adherence to statin therapy in the primary care clinical setting.
机译：临床试验表明，接受HMG-CoA还原酶抑制剂（他汀类药物）治疗的患者的低密度脂蛋白胆固醇（LDL-C）水平和冠心病（CHD）事件均显着降低。他汀类药物的次优剂量和他汀类药物的治疗质量在临床环境中导致他汀类药物的预期疗效与他汀类药物疗效之间存在差距，从而导致冠心病发病率和费用增加。先前的研究集中在患者或医生对此问题的贡献上。本文同时研究了患者他汀类药物依从性和初级保健医师（PCP）指南依从性对退伍军人相关健康结局的影响-退伍军人是高风险患者，药物和机构护理的障碍很少。 LDL-C目标实现的重要障碍，并且在控制潜在的依从性混杂因素之后仍然很重要。此外，本论文说明，即使先前达到患者的LDL-C目标，患者他汀类药物的依从性水平<100％仍降低了他汀类药物治疗对LDL-C管理的益处。；两项国家指南建议-医师随访和年度脂质监测-发现对他汀类药物依从性有积极影响。进行年度脂质评估的PCP比率的增加降低了冠心病事件或死亡的可能性，尤其是在没有心脏病史的患者中。他汀类药物依从性越高，发生冠心病事件或死亡的可能性越高。这种意外的关联可能是由于CHD风险较高的患者中较高的依从性，以及该研究处理疾病程度未测到的残留混杂物的能力有限。本论文的工作表明患者对他汀类药物的依从性和他汀类药物治疗的有效性在减少冠心病事件和死亡率方面，可以通过加强随访办公室访问和PCP的年度脂质评估相结合来改善。因此，由于冠心病的患病率和人口的老龄化，重要的是要进行更多的研究，以使PCP的做法与国家指导方针保持一致，并在初级保健临床环境中改善患者对他汀类药物治疗的依从性。

著录项

  • 作者

    Campione, Joanne Rita.;

  • 作者单位

    The University of North Carolina at Chapel Hill.;

  • 授予单位 The University of North Carolina at Chapel Hill.;
  • 学科 Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2005
  • 页码 129 p.
  • 总页数 129
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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