Adherence to combination therapy among ethnic Chinese patients: a cohort study

Abstract

Discontinuation of antihypertensive combination therapy imposes a substantial public health burden, but few studies have addressed the factors associated with their discontinuation in Chinese patients. This study evaluated the association between patient age, gender, and number of comorbidities with discontinuation of combination therapies. From clinical databases, we included all adult patients prescribed an antihypertensive fixed-dose combination therapy during January 2004 to June 2007 in any government primary care clinics in one large Territory of Hong Kong. We studied the factors associated with drug discontinuation within 180 days after the first prescription date by multivariable regression analysis, controlling for age, gender, socioeconomic status, service setting, district of residence, visit types (new vs. follow-up), and the number of comorbidities. From 29 253 eligible patients, 7.1% discontinued their antihypertensive prescriptions. Younger (<50 years; adjusted odds ratios [aOR]: 0.78, 95% confidence interval [CI]: 0.66-0.92 for patients aged 50-59 years, P=0.003; aOR: 0.71, 95% CI: 0.60-0.84 for patients aged 60-69 years, P<0.001) and male patients (aOR: 1.19, 95% CI: 1.08-1.31, P<0.001) were more likely to have drug discontinuation. Patients with one (aOR: 0.64, 95% CI: 0.57-0.73, P<0.001) and at least two (aOR: 0.68, 95% CI: 0.54-0.87, P=0.002) comorbidities were less likely to have their medications discontinued. Combination therapies in Chinese patients had a low discontinuation rate when compared with Caucasian patients. Discontinuation was more likely among younger, male patients and those without concomitant comorbidities, in which more meticulous monitoring of their adherence patterns was needed.

Association between the 8‐item Morisky medication adherence scale (MMAS‐8) score and glycaemic control among Chinese diabetes patients

“…Previous studies were either small‐scale, or provided limited information on the relationship between medication adherence and outcome measures such as diabetes control . Other studies were either conducted among hypertensive patients or based on electronic databases in which the computerized medication prescription records might not accurately reflect patients' drug‐taking behaviors in real life . It remains largely unknown whether the use of adherence scales from patient interviews (self‐administered surveys) could effectively predict one's level of glycaemic control.…”

Cardiovascular mortality in hypertensive patients newly prescribed perindopril vs. lisinopril: A 5-year cohort study of 15,622 Chinese subjects

“…Any changes of prescriptions after the initial consultation were also recorded. This database had also been described in previous publications [24][25][26][27][28][29][30][31][32][33]. The database was previously validated and demonstrated a high level of completeness on the sociodemographic information (100%) and prescription profiles (99.8%) [27].…”

The incidence of cancer deaths among hypertensive patients in a large Chinese population: A cohort study

“…It captures patients' demographic and prescription profiles, and clinical diagnoses in the forms of the International Classification of Diseases (ICD-9) or the International Classification of Primary Care (ICPC-2). The database has been previously reported with detailed descriptions on its validity [27][28][29][30][31][32][33][34], which demonstrated a high level of completeness with respect to the socio-demographic information (100%) and prescription profiles (99.98%) [29]. All drug prescriptions are entered by the attending physicians and are double-checked by the dispensing pharmacists using standardized procedures, and any subsequent changes in patients' prescription after the initial consultations are also entered into the system.…”