| Objective:1.Based on computer technology,an information management system for storing and analyzing data of patients with cerebrovascular disease was established.The database supports operations such as adding,deleting,and modifying data,and registering information of inpatients with cerebrovascular disease according to the database module.2.The patients with acute cerebral infarction were selected in the database.The medication adherence was followed up.The adherence of various medications at different times was evaluated,and the factors influencing the patient’s medication adherence were analyzed.3.The patients with acute cerebral infarction were selected in the database.The medication adherence and prognosis were followed up.To explore the various factors that affect the short-term and long-term prognosis of patients with acute cerebral infarction,and to discuss the influence of the patient’s medication adherence on the prognosis.Methods: 1.Design the basic structure of cerebrovascular disease database.The database was established under IIS7.5 environment and use ASP.NET+Easy UI framework as interface development tool,back-end SQL SERVER 2008 database as data storage platform.Information acquisition module was established,including patient basic information,demographic characteristics,personal history,past medication,in-hospital examination,hospital admission diagnosis,hospital-assisted examination,vascular events and complications during hospitalization,treatment,medication,final diagnosis,discharge situation,follow-up record.Administrators can perform operations such as adding,modifying,deleting and retrieving information in the database.Professional engineers regularly maintain the database and back up information.2.Information of acute cerebral infarction patients stored in the database was selected,including the demographics,past history,and general conditions.Follow up the patient’s medication adherence,and evaluate secondary prevention medication adherence in the patients of ischemic cerebrovascular disease.Analyze the differences in adherence of various medications at various times,the reasons for poor medication adherence,and the factors that affect adherence.3.Information of acute cerebral infarction patients stored in this database was selected,including demographic data,past history,general conditions,laboratory indicators,classification of stroke etiology and complications.Follow up patient’s prognosis and medication adherence.To analyze the factors that affect the short-term and long-term prognosis of patients,and to study the effect of medication adherence on short-term and long-term prognosis.Result: 1.A database of cerebrovascular disease was established.The database contains basic patient information,demographic characteristics,personal history,past medications,physical examination,admission diagnosis,in-hospital examinations,vascular events,complications,treatment,medication,final diagnosis,discharge situation and follow-up record.The database supports operations such as adding,deleting,modifying,and retrieving cases.The database platform was completed in March 2015 and data entry was started during the same period.2.496 cases of acute cerebral infarction patients stored in this database were included.The information of patients included demographic data,past history,and general conditions.Follow up medication adherence at 3 months,6 months,and 1 year.One-year follow-up of 426 patients was completed.Single-factor studies showed that age,history of diabetes,history of intravascular stent implantation,medical payment methods,and education levels were related to medication adherence(P<0.05).Logistic regression analysis showed a history of diabetes(OR=0.488,95%CI: 0.299~0.797,P=0.004),history of intravascular stent implantation(OR=0.196,95 %CI: 0.065~0.588,P=0.004),medical payment methods(OR=2.649,95%CI: 1.503~4.668,P=0.001),education level(OR=0.362,95%CI: 0.236~0.556,P= 0.000)were independent factors on impacting medication adherence.3.The medication adherence rates of antiplatelet drugs,anticoagulant,lipid-lowering drugs,antihypertensive drugs,and hypoglycemic drugs were 80.5%、70%、58.1%、95.3% and 91.4% at 1 year,respectively.Over time,medication adherence with antiplatelet drugs and lipid-lowering drugs decreased.The use rate of anticoagulant drugs is at the lowest level at each period.4.The reason of poor adherence for various types of medications was investigated at 1 year after the patient discharged from hospital.The top three reasons for poor adherence to antithrombotic drugs were worry about side effects(35.80%),spontaneous withdrawal after symptoms improved(32.1%),and adverse reactions(23.46%).The top three reasons for the poor adherence of lipid-lowering drugs were worry about drug side effects(35.50%),spontaneous withdrawal after symptoms improved(21.30%),and adverse reactions(14.79%).The top three reasons for the poor adherence of antihypertensive drugs were spontaneous withdrawal when blood pressure is normal(36.84%),lack of understanding of the disease(31.58%),and worry about side effects(21.05%).The top three reasons for poor adherence to hypoglycemic drugs were spontaneous withdrawal when glucose is normal(46.67%),worry about side effects(13.33%),and lack of understanding of the disease(13.33%).5.A total of 496 acute cerebral infarction patients were prospectively included in this database.The information of the collected patients included demographic data,past history,general conditions,laboratory indicators,classification of stroke etiology and complications.To evaluate the patient’s 3-month and 12-month prognosis and incorporating the patient’s medication adherence into the influencing factors to analyze the independent factors that influence the short-term prognosis and long-term prognosis of patients with acute cerebral infarction.The results showed that history of stroke or TIA(OR=1.890,95%CI:1.004~3.556,P=0.049),baseline NIHSS score(OR=1.425,95%CI:1.286~1.579,P=0.000),urinary incontinence(OR=4.147,95%CI:1.903~9.035,P=0.000)were independent factors for short-term prognosis of acute cerebral infarction;Age(OR=1.033,95%CI:1.007~ 1.059,P=0.012),history of stroke or TIA(OR=2.101,95%CI:1.110~3.975,P=0.023),baseline NIHSS score(OR=1.272,95%CI:1.154~1.403,P=0.000),urinary incontinence(OR=3.517,95%CI:1.560~7.928,P=0.002),medication adherence(OR=7.811,95%CI:4.107~14.856,P=0.000)were independent factors for long-term prognosis of acute cerebral infarction.Patients with good medication adherence have better long-term outcomes.Conclusion: 1.Establish a database of cerebrovascular disease.This database has features such as entry,modification,and deletion of case data.It can be used to store and manage information of patients with cerebrovascular disease,and to provide data support for exploring the causes and influencing factors,clinical features,and outcomes of cerebrovascular disease.2.History of diabetes,history of intravascular stent implantation,medical payment methods,and education levels were independent factors for medication adherence.Patients with history of diabetes,history of intravascular stenting implantation,outpatient medical insurance,and high educational level have better medication adherence.3.In the secondary prevention of ischemic stroke,the medication adherence rate to antihypertensive and antihyperglycemic drugs is better than antiplatelet drugs,anticoagulant,lipid-lowering drugs.The medication adherence rate of lipid-lowering drugs is the lowest and the use rate of anticoagulant drugs is at the lowest level.4.The main reasons for poor medication adherence were worry about drug side effects,spontaneous withdrawal after symptoms improved,and lack of understanding of the disease.5.History of stroke or TIA,baseline NIHSS score and urinary incontinence were independent factors affecting short-term and long-term prognosis in patients with acute cerebral infarction.Age,and medication adherence were independent factors that affect the long-term prognosis of patients.Medication adherence as a controllable factor affecting the long-term prognosis of ischemic cerebrovascular disease should be highly valued by physicians,patients and their families.Work together to improve patient medication adherence and lead to better long-term benefits. |
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