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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Factors Associated With the Initiation and Discontinuation of Secondary Stroke Prevention Agents in Nursing Homes
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Factors Associated With the Initiation and Discontinuation of Secondary Stroke Prevention Agents in Nursing Homes

机译：疗养院中次生卒中预防药物启动和停用的相关因素

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Background and Purpose: Little is known about factors relating to initiation and discontinuation of antiplatelet and anticoagulant therapies among stroke survivors in nursing homes. Methods: In 6 states from 1992 to 1996, we followed up stroke survivors admitted to nursing homes for at least 6 months; 9547 were not receiving any secondary stroke prevention treatment at admission, whereas 6244 were receiving therapy. Factors relating to initiation and discontinuation of drug therapy included resident factors (e.g., sociodemographics, clinical factors) and facility factors (e.g., for profit, part of a chain). Generalized estimating equations provided estimates of residents and facility characteristics adjusting for the clustering effects owing to the correlation of residents living within the same home. Results: In all, 12% initiated drug therapy; 30.3% discontinued, Conditions known to increase the risk of recurrent stroke (e.g., atrial fibrillation) were predictive of initiation. Black residents (odds ratio [OR] 0.62, 95% confidence interval [CI] 0,49-0.78) were less likely than non-Hispanic white residents to initiate therapy. American Indian (0R 1.16, 95% CI 0.80-1.68), black (OR 1.23, 95% CI 1.03-1.47), and Hispanic residents (OR 1.30, 95% CI 0.79-2.13) tended to be more likely than non-Hispanic white residents to discontinue therapy, with facility characteristics completely explaining the observed associations. Conclusions: In nursing homes, interventions to improve drug management of recurrent stroke are needed and implementation should occur without regard to a patient's skin color, Intervention studies may have little success in the nursing home setting if the context in which the care is given and financial/structural difficulties are not addressed in the implementation of such interventions.
机译：背景与目的：疗养院中风幸存者中与抗血小板和抗凝疗法的启动和终止有关的因素鲜为人知。方法：从1992年至1996年在6个州中，我们对入院的中风幸存者进行了至少6个月的随访;入院时9547名未接受任何中风预防治疗，而6244名正在接受治疗。与药物治疗的开始和终止有关的因素包括居民因素（例如，社会人口统计学，临床因素）和设施因素（例如，为了获利，是连锁的一部分）。由于居住在同一房屋内的居民之间的相关性，广义估计方程为居民和设施特征的估计提供了聚类效果的调整。结果：总共有12％的人开始药物治疗;停药30.3％，已知会增加中风复发风险（如房颤）的病情可预示开始。黑人居民（优势比[OR]为0.62，95％置信区间[CI]为0.49-0.78）比非西班牙裔白人居民发起治疗的可能性更低。美洲印第安人（0R 1.16，95％CI 0.80-1.68），黑人（OR 1.23，95％CI 1.03-1.47）和西班牙裔居民（OR 1.30，95％CI 0.79-2.13）比非西班牙裔人更有可能白人居民停止治疗，其设施特征完全解释了观察到的关联。结论：在疗养院中，需要采取干预措施来改善复发性中风的药物管理，并且应在不考虑患者肤色的情况下进行实施。如果进行护理和提供财务支持，干预研究在疗养院中可能会收效甚微。实施此类干预措施未解决/结构性困难。

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