Al-Zakwani Ibrahim S, Barron John J, Bullano Michael F, Arcona Steve, Drury Christopher J, Cockerham Tara R
Health Core, Inc., Newark, DE 19713, USA.
Curr Med Res Opin. 2003;19(7):619-26. doi: 10.1185/030079903125002270.
To examine the effects of typical and atypical antipsychotics on medication adherence and healthcare resource utilization.
This was a retrospective observational cohort analysis of pharmacy and medical health insurance reimbursement data of patients from a southeastern United States health plan. Pharmacy data of subjects between 6 and 65 years of age were identified. Inclusion criteria included initiation of a single antipsychotic agent between July 1, 1999 and September 30, 2000; no antipsychotic medication usage 6 months prior to the index prescription date; and continuous health plan enrollment for the 18-month study period. Multivariable methods were utilized to analyze healthcare resource utilizations between groups.
Primary outcome measures included: (1) adherence and persistence with antipsychotic therapy; (2) healthcare utilization for outpatient office and hospital visits, inpatient hospital visits, and emergency room visits; and (3) therapy modifications and concomitant medications.
A total of 469 patients met initial study criteria. Atypical and typical antipsychotics were prescribed to 384 and 85 patients, respectively. Length of therapy (days) for the atypical cohort was significantly longer (136 vs 80; p < 0.001). As defined using medication possession ratio (MPR), the atypical cohort was significantly more adherent to therapy than the typical cohort (mean MPR, 0.53 vs 0.24; p < 0.001). After adjusting for differences in demographics, baseline utilization, MPR, and length of therapy (n = 377), the atypical cohort experienced significantly fewer office visits (2,635 vs 4,249 per 1000 patients per month [P1000PPM]; p = 0.005), fewer inpatient admissions (197 vs 511 P1000PPM; p = 0.032), and fewer emergency room visits (125 vs 354 P1000PPM; p = 0.002).
Atypical antipsychotic users were significantly more adherent to therapy, and had lower rates of office, hospital and emergency room utilization. Within the context of inherent limitations associated with health insurance claims databases, this study suggests that a relationship exists across cohorts between medication adherence and use of healthcare resources.
研究典型和非典型抗精神病药物对药物依从性和医疗资源利用的影响。
这是一项对美国东南部一个健康计划中患者的药房和医疗保险报销数据进行的回顾性观察队列分析。确定了6至65岁受试者的药房数据。纳入标准包括在1999年7月1日至2000年9月30日期间开始使用单一抗精神病药物；在索引处方日期前6个月未使用抗精神病药物；以及在18个月的研究期间持续参加健康计划。采用多变量方法分析各组之间的医疗资源利用情况。
主要观察指标包括：（1）抗精神病治疗的依从性和持续性；（2）门诊、住院和急诊就诊的医疗利用情况；（3）治疗调整和伴随用药情况。
共有469名患者符合初始研究标准。非典型和典型抗精神病药物分别开给了384名和85名患者。非典型队列的治疗时长（天数）显著更长（136天对80天；p<0.001）。按照药物持有率（MPR）定义，非典型队列的治疗依从性显著高于典型队列（平均MPR，0.53对0.24；p<0.001）。在对人口统计学、基线利用率、MPR和治疗时长的差异进行调整后（n = 377），非典型队列的门诊就诊次数显著更少（每1000名患者每月2635次对4249次[每1000患者每月就诊次数，P1000PPM]；p = 0.005），住院次数更少（197次对511次P1000PPM；p = 0.032），急诊就诊次数更少（125次对354次P1000PPM；p = 0.002）。
使用非典型抗精神病药物的患者治疗依从性显著更高，门诊、住院和急诊利用率更低。在与医疗保险理赔数据库相关的固有局限性背景下，本研究表明不同队列之间在药物依从性和医疗资源利用之间存在关联。
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