clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.37489/2588-0519-2021-4-44-52clinvest-595Research ArticleФАРМАКОЭПИДЕМИОЛОГИЯPHARMACOEPIDEMIOLOGYМногофакторный анализ приверженности фармакотерапии среди амбулаторных пациентов со стабильной ишемической болезнью сердцаMultivariate analysis of medication adherence among outpatients with stable coronary artery diseaseФитилёвС. Б.FitilevS. B.

Фитилёв Сергей Борисович, д. м. н., профессор

SPIN-код: 8287-8456

Москва

Fitilev Sergey B., Dr. Sci. (Med.), professor

SPIN code: 8287-8456 

Moscow

https://orcid.org/0000-0002-2687-5986ВозжаевА. В.VozzhaevA. V.

Возжаев Александр Владимирович, д. фарм. н., доцент

SPIN-код: 8637-8963 

Москва

Vozzhaev Alexander V., Dr. Sci. (Pharm.), associate professor 

SPIN code: 8637-8963

Moscow

alex.vozzhaev@gmail.comhttps://orcid.org/0000-0003-2400-3938КлюевД. А.KliuevD. A.

Клюев Дмитрий Алексеевич, ассистент

SPIN-код: 8960-7798 

Москва

Kliuev Dmitry A., assistant professor 

SPIN code: 8960-7798

Moscow

ШкребнёваИ. И.ShkrebniovaI. I.

Шкребнёва Ирина Ивановна, доцент

SPIN-код: 1105-5760

Москва

Shkrebniova Irina I., associate professor

SPIN code: 1105-5760 

Moscow

ФГАОУ ВО «Российский университет дружбы народов», Медицинский институт, кафедра общей и клинической фармакологииРоссияPeoples’ Friendship University of Russia, Medical Institute, Department of General and Clinical PharmacologyRussian Federation202113022022044452Copyright © Фитилёв С.Б., Возжаев А.В., Клюев Д.А., Шкребнёва И.И., 20222022Фитилёв С.Б., Возжаев А.В., Клюев Д.А., Шкребнёва И.И.Fitilev S.B., Vozzhaev A.V., Kliuev D.A., Shkrebniova I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/595

Актуальность. Результаты отечественных исследований показали, что приверженность фармакотерапии амбулаторных больных ишемической болезнью сердца (ИБС) находится на низком уровне (не более 60 %). Поиск значимых предикторов, оказывающих влияние на степень соблюдения пациентами рекомендованной терапии, позволит обоснованно подойти к разработке специальных стратегий по контролю приверженности лечению с целью оптимизации фармакотерапии ИБС в условиях реальной клинической практики первичного звена здравоохранения. Цель. Определить факторы, ассоциированные с уровнем приверженности фармакотерапии среди амбулаторных больных стабильной ИБС. Материал и методы. Настоящая работа посвящена фрагменту рандомизированного контролируемого исследования влияния программы «Фармацевтическая опека» на приверженность фармакотерапии амбулаторных больных стабильной ИБС, проведённому в 2019-2020 гг. в одной из поликлиник г. Москвы. Согласно установленным критериям отбора было включено 123 пациента. Регистрировались данные демографии, социального статуса, анамнеза, фармакотерапии ИБС, нагрузки на здравоохранение. Уровень приверженности пациентов фармакотерапии оценивался с помощью валидизированного опросника MMAS-8 (Morisky Medication Adherence Scale; 8-вопросная версия шкалы Мориски - Грина). Анализ предикторов приверженности проводился методом линейной регрессии. Результаты. Простой регрессионный анализ позволил установить перечень параметров, которые при построении линейных однофакторных моделей показали достоверную (или на уровне статистической тенденции) связь с приверженностью больных ИБС фармакотерапии. Было обнаружено, что уровень приверженности ассоциирован с наличием у пациента опекуна или партнёра (p=0,002), высшего образования (p=0,009), использованием ДЛО (p=0,006). Приверженность лечению не зависела от основных анамнестических характеристик больных ИБС и структуры назначенной фармакотерапии, но при этом была выявлена взаимосвязь высоких значений холестерина липопротеинов низкой плотности (ХС-ЛПНП) с недостаточной приверженностью (p=0,001). Удалось продемонстрировать наличие статистически значимой ассоциации более высокого уровня приверженности с количеством посещений пациентом врача общей практики (p=0,036) и на уровне тенденции - врача-кардиолога (p=0,093). В результате второго этапа регрессионного анализа была предложена многофакторная модель, включившая два независимых положительных предиктора приверженности: наличие у пациента опекуна или партнёра (р=0,015) и регулярное посещение врача-кардиолога (р=0,025). Также была подтверждена отрицательная взаимосвязь в отношении высокого уровня ХС-ЛПНП (р=0,002). Заключение. Выявлены независимые предикторы более высокого уровня приверженности фармакотерапии амбулаторных больных стабильной ИБС: наличие у пациента партнёра или опекуна и регулярное посещение врача-кардиолога. Недостаточно приверженные больные ИБС имели более высокие значения ХС-ЛПНП.

Introduction. The results of local studies indicated that medication adherence of coronary outpatients is low (not more than 60 %). The search for significant predictors of adherence to recommended treatment might allow tailoring specific strategies to control adherence for further optimization of the pharmacotherapy of coronary artery disease (CAD) in routine primary care practice. Aim. To determine the factors associated with medication adherence in outpatients with stable CAD. Methods. This paper describes the results of the fragment of randomized controlled study of the effects of Pharmacy Care Program on medication adherence of coronary outpatients, that was conducted in 2019-2020 in one of the primary care clinics of Moscow. 123 subjects with stable CAD were included in line with the pre-specified criteria. Demography, social status, medical history, pharmacotherapy, healthcare burden data were registered. Medication adherence was measured by validated questionnaire MMAS-8 (8-item Morisky Medication Adherence Scale). The analysis of predictors of adherence was performed by linear regression. Results. Simple regression analysis revealed the list of parameters, that showed statistically significant (or as statistical trend) association with medication adherence of coronary patients in univariate models. The level of medication adherence was associated with patient’s having a partner or caregiver (p=0,002), higher education (p=0,009), additional medicinal maintenance (p=0,006). Medication adherence did not depend on medical history and pharmacotherapy characteristics, but the association of high values of low-density lipoproteins cholesterol (LDL-C) (p=0,001) with suboptimal adherence was demonstrated. Good medication adherence was associated with more frequent visits to general practitioner (p=0,036) and (as statistical trend) to cardiologist (p=0,093). The multivariate regression analysis revealed two positive independent predictors of medication adherence - patient’s having a partner or caregiver (р=0,015) and regular visits to cardiologist (р=0,025). Also, the negative association was confirmed for high LDL-C (р=0,002). Conclusion. Patient’s having a partner or caregiver and regular visits to cardiologist were revealed as independent predictors of good medication adherence of coronary outpatients. Subjects with suboptimal adherence had higher LDL-C.

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The authors declare that there are no conflicts of interest present.