Kronish Ian M, Federman Alex D, Morrison R Sean, Boal Jeremy
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA.
J Gerontol A Biol Sci Med Sci. 2006 Apr;61(4):411-5. doi: 10.1093/gerona/61.4.411.
The number of medically homebound adults has grown with the aging of the U.S. population, yet little is known about their health care utilization. We sought to characterize the health status and medication utilization of an urban cohort of homebound adults and to identify factors associated with medication use in this population.
We performed a retrospective cross-sectional analysis of 415 patients enrolled in a primary care program for homebound adults in New York City during October 2002. Numbers of medications were obtained from formularies corroborated by home visits. For patients without prescription insurance, medication out-of-pocket costs were estimated according to average wholesale pricing. Sociodemographic and disease characteristics were obtained by chart abstraction.
The median age was 83 years (range 25-106 years). Seventy-seven percent of patients were female, 63% were non-white, and 28% spoke Spanish. Sixty-four percent of patients had Medicaid. The cohort had a mean of 8.2 (range 1-27, standard deviation 4.5) medications prescribed per month. Multivariate analysis showed that increasing age was associated with fewer medications (p <.001). Charlson comorbidity score was positively associated with number of medications (p <.001), whereas Activities of Daily Living score, a measure of functional dependence, was not. Twenty-seven percent of the cohort lacked prescription drug coverage. The total number of medications per month among the uninsured patients was 7.4 (standard deviation 4.4). Estimated median monthly out-of-pocket cost for the uninsured patients was dollar 223 (range dollar 1-dollar 1512).
For homebound patients without prescription drug coverage, medication use may represent substantial financial burden. Additional research is needed to determine whether out-of-pocket medication costs represent a barrier to care in this population.
随着美国人口老龄化，需医疗护理的居家成年人数量有所增加，但对他们的医疗保健利用情况却知之甚少。我们试图描述居家成年人城市队列的健康状况和药物使用情况，并确定该人群中与药物使用相关的因素。
我们对2002年10月在纽约市一个针对居家成年人的初级保健项目中登记的415名患者进行了回顾性横断面分析。通过家访核实的处方集获取药物数量。对于没有处方保险的患者，根据平均批发价格估算药物自付费用。通过病历摘要获取社会人口统计学和疾病特征。
中位年龄为83岁（范围25 - 106岁）。77%的患者为女性，63%为非白人，28%讲西班牙语。64%的患者有医疗补助。该队列每月平均开具8.2种（范围1 - 27种，标准差4.5）药物。多变量分析显示，年龄增长与药物数量减少相关（p <.001）。查尔森合并症评分与药物数量呈正相关（p <.001），而作为功能依赖衡量指标的日常生活活动评分则不然。27%的队列缺乏处方药保险。未参保患者每月的药物总数为7.4种（标准差4.4）。未参保患者估计的每月自付费用中位数为223美元（范围1 - 1512美元）。
对于没有处方药保险的居家患者，药物使用可能带来巨大的经济负担。需要进一步研究以确定自付药物费用是否是该人群获得医疗护理的障碍。
