Piette John D, Heisler Michele
Department of Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan 48113, USA.
J Am Geriatr Soc. 2006 Jan;54(1):91-6. doi: 10.1111/j.1532-5415.2005.00527.x.
To determine whether chronically ill patients have gaps in knowledge about their prescription drug coverage and establish the relationship between gaps and medication cost problems.
Nationwide, cross-sectional survey.
Nationwide survey conducted via the Internet.
Three thousand one hundred nineteen adults aged 50 and older (1,400 of whom were aged > or = 65) who had prescription drug coverage and at least one chronic illness.
Patients were asked about features of their drug benefits and whether they had experienced problems due to medication costs in the prior year.
Twenty-five percent of respondents reported not knowing their usual prescription copayments, and 41% did not know whether there were caps on their drug coverage. Nonwhite race and lower income were independent risk factors for lack of knowledge about these aspects of pharmacy benefits. Lack of knowledge regarding the limits of coverage was associated with a greater likelihood of cutting back on medication use because of cost pressures, forgoing basic needs because of medication costs, borrowing money to pay for prescriptions, and worrying about medication costs (all P<.05).
Many older adults with prescription drug coverage do not know important features of their pharmacy benefits. Racial minorities and those with low incomes may have the greatest difficulty understanding coverage and as a result may be at greatest risk for underusing their benefits. Education about Medicare reforms and other efforts to increase prescription coverage should accompany these policies.
确定慢性病患者在处方药保险覆盖范围的知识方面是否存在差距，并确定这些差距与药物费用问题之间的关系。
全国性横断面调查。
通过互联网进行的全国性调查。
3119名年龄在50岁及以上的成年人（其中1400人年龄≥65岁），他们有处方药保险且至少患有一种慢性病。
询问患者其药物福利的特点以及他们在前一年是否因药物费用而遇到问题。
25%的受访者表示不知道他们通常的处方药自付费用，41%的人不知道他们的药物保险是否有上限。非白人种族和低收入是对药房福利这些方面缺乏了解的独立风险因素。对保险覆盖范围限制缺乏了解与因成本压力而减少用药、因药物费用而放弃基本需求、借钱支付处方药费用以及担心药物费用的可能性更大有关（所有P<0.05）。
许多有处方药保险的老年人不知道他们药房福利的重要特点。少数族裔和低收入者在理解保险覆盖范围方面可能有最大困难，因此可能最有可能未充分利用他们的福利。在推行这些政策的同时，应开展关于医疗保险改革的教育及其他提高处方药覆盖范围的工作。
