title: Pattern of statin use in southern italian primary care: can prescription databases be used for monitoring long-term adherence to the treatment?
abstract: OBJECTIVE
  We sought to evaluate the prescribing pattern of statins according to national and regional health policy interventions and to assess specifically the adherence to the therapy in outpatient setting in Southern Italy.
  
  
  METHODS
  A population-based study was performed on persons ≥15 years old, living in the catchment area of Caserta (Southern Italy), and registered in Arianna database between 2004 and 2010. Prevalence and incidence of new treatments with statins were calculated for each year and stratified by drug. Adherence to therapy was measured by Medication Possession Ratio. Sub-analyses by individual compound and type of cardiovascular prevention were performed.
  
  
  RESULTS
  From 2004 to 2010, the one-year prevalence of statin use increased from 44.9/1,000 inhabitants to 79.8/1,000, respectively, consistently with the incidence of new use from 16.2/1,000 to 19.5/1,000, except a slight decrease after criteria reimbursement revision on 2005 (13.3/1,000). The incidence of new treatments decreased for atorvastatin, and increased for simvastatin over the study years. Overall, 43% of new users were still highly adherent to the treatment (MPR≥80%) after six months, while 26% after 4-years of follow-up. As compared with highly adherent patients, the probability to be non-adherent (MPR≤25%) at 4-years of follow-up was 26% higher for women than for men (full adj. odds ratio: 1.26; 95% CI: 1.10-1.45), and 64% higher in patients who started on primary rather than on secondary prevention (1.64; 1.29-2.07).
  
  
  CONCLUSIONS
  Prevalence and incidence of statin use increased consistently with health policy interventions. Only one-fourth of patients who newly initiated a statin were adherent to the treatment after 4-year of follow-up. Since the benefits of statins in terms of cardiovascular outcome and costs are associated with their chronic use, the identification of patient-related predictors of non-adherence such as gender, primary prevention could be suitable for physicians to improve the patients' compliance.
authors: Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy; Medical Informatics Department, Erasmus University Medical Centre, Rotterdam, Netherlands.
authors: Carmen
authors: C
authors: Ferrajolo
authors: Clinical and Experimental Medicine Department, University of Messina, Messina, Italy.
authors: Vincenzo
authors: V
authors: Arcoraci
authors: Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy.
authors: Maria Giuseppa
authors: MG
authors: Sullo
authors: Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy.
authors: Concetta
authors: C
authors: Rafaniello
authors: Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy.
authors: Liberata
authors: L
authors: Sportiello
authors: Clinical and Experimental Medicine Department, University of Messina, Messina, Italy.
authors: Rosarita
authors: R
authors: Ferrara
authors: Clinical and Experimental Medicine Department, University of Messina, Messina, Italy.
authors: Angelo
authors: A
authors: Cannata
authors: Local Health Unit of Caserta, Caserta, Italy.
authors: Claudia
authors: C
authors: Pagliaro
authors: Local Health Unit of Caserta, Caserta, Italy.
authors: Michele Giuseppe
authors: MG
authors: Tari
authors: Medical Informatics Department, Erasmus University Medical Centre, Rotterdam, Netherlands.
authors: Achille Patrizio
authors: AP
authors: Caputi
authors: Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy.
authors: Francesco
authors: F
authors: Rossi
authors: Medical Informatics Department, Erasmus University Medical Centre, Rotterdam, Netherlands; Clinical and Experimental Medicine Department, University of Messina, Messina, Italy.
authors: Gianluca
authors: G
authors: Trifirò
authors: Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy.
authors: Annalisa
authors: A
authors: Capuano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D017723:Drug Utilization Review; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D007558:Italy; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D055656:Prescriptions; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors