Adhésion au traitement de la maladie rénale chronique chez les québécois âgés de 18 ans ou plus
|Authors:||Truong, Viet Thanh|
|Advisor:||Grégoire, Jean-Pierre; Moisan, Jocelyne|
|Abstract:||Introduction: As chronic kidney disease (CKD) progresses, the risk of cardiovascular diseases increases. Hypertension, diabetes and dyslipidemia are often seen as risk factors and co-morbidity in patients with CKD. For those who undertake an antihypertensive drug (AHD), a lipid-lowering drug (LLD) or an antidiabetic drug (AD), persistence and compliance with those treatments are important to benefit from the expected reduction in cardiovascular morbidity and mortality. Persistence and compliance with these drug treatments have not been well studied in patients with CKD. Objectives: From each of three treatments, i.e. AHD, LLD and AD, in CKD patients, our study aimed 1) to estimate the persistence with treatment one year after treatment initiation; 2) among those persisting, to estimate compliance in the year following treatment initiation; 3) to identify factors associated with persistence; and 4) to identify factors associated with compliance. Methods: Using Quebec administrative databases, we carried out three cohort studies composed of individuals aged ≥18 years, the first one of patients who had started any AHD, the second one of individuals who had initiated any LLD and the last one of individuals who had started any AD between January 1, 2000 and December 31, 2011. Individuals still undergoing treatment with any of these drugs one year after their first claim were considered persistent. Of these, we considered compliant those with a supply of drugs for ≥80% of days during the first year of treatment. We identified factors associated with persistence and with compliance using modified Poisson regression. Results: Among 7,119 eligible patients, 78.8% were persistent and 87.7% of those persisting were compliant with their AHD. Patients more likely to be persistent were users of angiotensin-converting enzyme inhibitor monotherapy (ACEI) (PR: 1.20; 95% CI: 1.13-1.27), angiotensin II receptor blocker monotherapy (ARB) (1.22; 1.14-1.31), calcium channel blocker monotherapy (CCB) (1.20; 1.14-1.26), beta-blocker monotherapy (BB) (1.16; 1.10-1.23) and multitherapy (1.31; 1.25-1.38) (vs. diuretic monotherapy (DIU)). Individuals more likely to be compliant were users of ACEI (1.08; 1.03-1.014), BB (1.10; 1.05-1.15), CCB (1.10; 1.05-1.15) and multitherapy (1.15; 1.11-1.20). Among 14,607 eligible individuals who initiated a LLD, 80.7% were persistent and 88.7% of these were compliant with their LLD. Individuals more likely to be persistent with LLD were patients with a low socio-economic status (SES) (1.03; 1.01-1.06) (vs. high SES) and patients whose treatment was initiated by a nephrologist (1.06; 1.04-1.09) (vs. general practitioner). Individuals who were more likely to be compliant were patients aged ≥66 years (vs. 18-65) (1.04; 1.01-1.07), patients with a low SES (1.08; 1.06-1.10) and those who used ≥12 distinct drugs (vs. < 7) (1.03; 1.0-1.05). Of the 6,671 individuals who initiated an AD, 76.9% were persistent with their AD treatment. Of those, 87.9% were compliant. Individuals with a low SES (1.04; 1.01-1.07) (vs. high SES), those on a multitherapy (1.12; 1.08-1.16) (vs. metformin monotherapy) and those who had one comorbidity such as hypertension (1.04; 1.01-1.07), dyslipidemia (1.06; 1.03-1.10), stroke (1.05; 1.01-1.11) or coronary disease (1.03; 1.01-1.06) were more likely to be persistent. Individuals more likely to be compliant were those with a medium SES (1.03; 1.01-1.07) or a multitherapy (1.06; 1.03-1.09). Conclusions: One year after treatment initiation, about 30% of CKD patients were either no longer taking or had not been compliant with the treatment regardless of the type of treatment initiated. We found some factors consistently associated with persistence including stroke, coronary disease and number of physician visits, while age and SES were consistently associated with compliance regardless of the type of treatment.|
|Document Type:||Thèse de doctorat|
|Open Access Date:||24 April 2018|
|Collection:||Thèses et mémoires|
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