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- Title
Socio-demographic differences in adherence to evidence-based drug therapy after hospital discharge from acute myocardial infarction: a population-based cohort study in Rome, Italy.
- Authors
Kirchmayer, U.; Agabiti, N.; Belleudi, V.; Davoli, M.; Fusco, D.; Stafoggia, M.; Arcà, M.; Barone, A. P.; Perucci, C. A.
- Abstract
Summary What is known and Objective: Adherence to evidence-based drug therapy after acute myocardial infarction has increased over the last decades, but is still unsatisfactory. Our objectives are to set out to analyse patterns of evidence-based drug therapy after acute myocardial infarction (AMI), and evaluating socio-demographic differences. Methods: A cohort of 3920 AMI patients discharged from hospital in Rome (2006-2007) was selected. Drugs claimed during the 12 months after discharge were retrieved. Drug utilization was defined as density of use (boxes claimed/individual follow-up; chronic use = 6+ boxes/365 days) and therapeutic coverage, calculated through Defined Daily Doses (chronic use: ≥80% of individual follow-up). Patterns of use of single drugs and their combination were described. The association between poly-therapy and gender, age and socio-economic position (small-area composite index based on census data) was analysed through logistic regression, accounting for potential confounders. Results and Discussion: Most patients used single drugs: 90·5% platelet aggregation inhibitors (antiplatelets), 60·0%β-blockers, 78·1% agents acting on the renin-angiotensin system (ACEIs/ARBs), 77·8% HMG CoA reductase inhibitors (statins). Percentages of patients with ≥80% of therapeutic coverage were 81·9% for antiplatelets, 17·8% for β-blockers, 64·4% for ACEIs/ARBs and 76·1% for statins. The multivariate analysis showed gender and age differences in adherence to poly-therapy (females: OR = 0·84; 95% CI 0·72-0·99; 71-80 years age-group: OR = 0·82; 95% CI 0·68-0·99). No differences were observed with respect to socio-economic position. What is new and Conclusion: The availability of information systems offers the opportunity to monitor the quality of care and identify weaknesses in public health-care systems. Our results identify specific factors contributing to non-adherence and hence define areas for more targeted health-care interventions. Our results suggest that efforts to improve adherence should focus on women and older patients.
- Subjects
ITALY; CLINICAL drug trials; CONFIDENCE intervals; DRUG monitoring; DRUG utilization; EPIDEMIOLOGY; LONGITUDINAL method; MULTIVARIATE analysis; MYOCARDIAL infarction; HEALTH outcome assessment; PATIENT compliance; POPULATION geography; STATISTICS; EVIDENCE-based medicine; LOGISTIC regression analysis; DATA analysis; SOCIOECONOMIC factors; DISCHARGE planning; TREATMENT effectiveness; POLYPHARMACY; DESCRIPTIVE statistics
- Publication
Journal of Clinical Pharmacy & Therapeutics, 2012, Vol 37, Issue 1, p37
- ISSN
0269-4727
- Publication type
Article
- DOI
10.1111/j.1365-2710.2010.01242.x