Medication adherence, dietary quality, medical utilization and mortality in Taiwanese elderly with hypertension

• Main Authors: HSIEH, TSUNG-LIN, 謝宗霖
• Other Authors: LEE, MEEI-SHYUAN
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/ew446t

碩士 === 國防醫學院 === 公共衛生學研究所 === 105 === Patients with a high compliance for placebo usage have hospitalization and mortality rates comparable to those in the corresponding treatment group. This is referred to as the “healthy adherer effect”. The Nutrition and Health Survey in Taiwan (NAHSIT) for 1999-2000, was linked to the National Health Insurance Research Databases until the end of 2006 (n=1290), inclusive of the pharmacological claim data, and to Death Registration until the end of 2008. This allowed the calculation of the average medication possession ratio (MPR) for Taiwanese elderly. An average MPR ≥ 80% is regarded as high adherence. Thus, the relationships between medication adherence and/or healthy adherer behavior for medical utilization with mortality could be explored. The characteristics of elderly with high medication adherence were found to be higher BMI, urban living, a higher level of education and considerable nutrition awareness, reflected in higher dietary quality scores (measured by the Overall Dietary Intake-Revised), and taking dietary supplements. However, at the same time, the Charlson Co-morbidity Index (CCI) was greater, as was medical utilization, even when corrected for healthy adherer behavior. With more medical utilization, total medical expense can be expected to rise unless there is a preventative benefit. Some chronic ambulatory care services have this characteristic. Sensitivity analysis was conducted by comparison with participants with abnormal blood pressure and normal blood pressure, but who avoided anti-hypertensive pharmacotherapy. Thus, the four groups of sensitivity analysis were the treated groups with different compliance (high/low), and the untreated groups with different blood pressure (normal/abnormal). Men with untreated abnormal blood pressure had the highest emergency department utilization, and hospitalization or cardiovascular-related medical utilization compared to the other treated groups of varying adherence; and similarly for women. The risk of death was 1.01-fold higher in men with abnormal blood pressure than their poorly adherent counterparts (p = 0.023); correspondingly, for women, mortality risk was 2.29 times (p = 0.002). In this study, we observed no advantage in less medical utilization for elderly people with a high medication adherence, either because they still had poor blood pressure control or because of multiple comorbidities, notwithstanding their use of the prescribed medication.