Adherence to lipid-lowering agents among 11,042 patients in clinical practice

AIMS

Dyslipidaemia is a poorly-controlled condition in clinical practice largely because of poor adherence to medication regimens by patients. This study evaluated the levels of and factors associated with adherence to lipid-lowering agents in a large Chinese population.

METHODS

From a validated clinical database, we included all patients who attended any public, primary care clinics in one large Territory of Hong Kong for medication refill at least twice during the study period January 2004 to June 2007. The major outcome variable was Medication Possession Ratio (MPR), an internationally-recognised metric to measure drug adherence. The factors associated with optimal drug adherence (MPR ≥ 0.8) were evaluated by multivariate regression analysis.

RESULTS

From 11,042 eligible patients, 90% were adherent. After adjusting for patients' age, gender, socioeconomic status, service type, district of residence, visit type (new visits vs. follow-up visits), the number of comorbidities and the drug class (statin vs. fibrates), older patients [aged 50-59 years; adjusted odds ratio (AOR) 1.30, p = 0.009; 60-69 years; AOR 1.53, p < 0.001; ≥ 70 years; AOR 1.72, p < 0.001], attendance in family medicine specialist clinics (FMSC; AOR 1.56, p < 0.001), follow-up visits (AOR 2.93, p < 0.001) and the presence of comorbidities (one comorbidity; AOR 1.45, p < 0.001; ≥ 2 comorbidities; AOR 1.56, p < 0.001) were associated with optimal drug adherence.

DISCUSSION AND CONCLUSION

These findings carry an implication that younger subjects, new patients, visitors in clinics other than FMSC and those without comorbidities should receive more meticulous monitoring of their medication-taking behaviour. Future studies should evaluate the major reasons for non-adherence among them.

A comparison of the acceptance of immunochemical faecal occult blood test and colonoscopy in colorectal cancer screening: a prospective study among Chinese

BACKGROUND

Preferences to choose immunochemical faecal occult blood test (FIT) and colonoscopy as colorectal cancer (CRC) screening modalities among asymptomatic Chinese subjects remain unknown.

AIM

To evaluate the preference of choosing colonoscopy vs. FIT among CRC screening participants.

METHODS

From a community-based CRC screening programme for asymptomatic Hong Kong Chinese aged 50-70 years, participants attended standardized educational sessions and chose the options of annual FIT for 5 years or direct colonoscopy once. Factors associated with choosing colonoscopy were evaluated by multivariate regression analysis.

RESULTS

Among 3430 participants [mean age 56.8 years (s.d. 5.0); female 55.1%, male 44.9%], 51.3% chose colonoscopy and 48.7% chose FIT. Older participants (65-70 years) were less likely to choose colonoscopy [adjusted odds ratio (aOR) 0.731, P = 0.041]. Subjects who chose colonoscopy were those disagreed screening would lead to discomfort (aOR 1.356, P < 0.001), had relatives or friends who had CRC (first degree relatives aOR 1.679, P < 0.001; second degree relatives aOR 1.304, P = 0.019; friends or others aOR 1.252, P = 0.026) and those who self-perceived their health as poor (aOR 1.529, P = 0.025).

CONCLUSIONS

Faecal occult blood test and direct colonoscopy were equally preferable to Chinese. Colonoscopy was preferred among the younger subjects, those with positive family history of CRC and self-perceived poor health status.

Factors associated with compliance, discontinuation and switching of calcium channel blockers in 20,156 Chinese patients

BACKGROUND

Noncompliance and nonpersistence to antihypertensive drugs is a recognized worldwide problem. Calcium channel blockers (CCBs) are commonly prescribed among Chinese patients yet few studies have been conducted to study the factors associated with their compliance, discontinuation, and switching profiles.

METHODS

From clinical databases we studied 20,156 patients prescribed a CCB as their antihypertensive monotherapy from January 2004 to June 2007 in a large Territory of Hong Kong. We evaluated their compliance by medication possession ratios (MPRs), cumulative incidences of discontinuation and switching within 180 days after the prescription; and evaluated their associated factors using multivariable logistic regression analyses.

RESULTS

The crude compliance level, discontinuation and switching rates at 180 days were 85.0, 3.1, and 5.0%, respectively. Older patients (aged > or =50 years; adjusted odds ratio (aOR) 1.21-1.34, P < 0.001), female gender (aOR 0.89, 95% confidence interval (CI) 0.82-0.96 for males, P = 0.004), fee payers (aOR 1.09, 95% CI 1.00-1.20, P = 0.050), service settings in family medicine specialist clinic (FMSC) (aOR 1.64, 95% CI 1.33-2.01, P < 0.001), and follow-up visits (aOR 3.24, 95% CI 2.93-3.58, P < 0.001) were positively associated with good compliance. Younger age and new visits were significantly associated with drug discontinuation or switching.

CONCLUSIONS

Younger patients, male subjects, and new visitors were more likely to be noncompliant to CCB among ethnic Chinese. They represent the target subjects where primary care physicians should spend more effort on patient education to improve drug compliance.