Wilson Ira B, Schoen Cathy, Neuman Patricia, Strollo Michelle Kitchman, Rogers William H, Chang Hong, Safran Dana Gelb
Tufts-New England Medical Center, Boston, MA 02111, USA.
J Gen Intern Med. 2007 Jan;22(1):6-12. doi: 10.1007/s11606-006-0093-0. Epub 2007 Jan 5.
Understanding and improving the quality of medication management is particularly important in the context of the Medicare prescription drug benefit that took effect last January 2006.
To determine the prevalence of physician-patient dialogue about medication cost and medication adherence among elderly adults nationwide.
Cross-sectional survey.
National stratified random sample of community-dwelling Medicare beneficiaries aged 65 and older.
Rates of physician-patient dialogue about nonadherence and cost-related medication switching.
Forty-one percent of seniors reported taking five or more prescription medications, and more than half has 2 or more prescribing physicians. Thirty-two percent overall and 24% of those with 3 or more chronic conditions reported not having talked with their doctor about all their different medicines in the last 12 months. Of seniors reporting skipping doses or stopping a medication because of side effects or perceived nonefficacy, 27% had not talked with a physician about it. Of those reporting cost-related nonadherence, 39% had not talked with a physician about it. Thirty-eight percent of those with cost-related nonadherence reported switching to a lower priced drug, and in a multivariable model, having had a discussion about drug cost was significantly associated with this switch (odds ratio [OR] 5.04, 95% confidence interval [CI] 4.28-5.93, P < .001).
We show that there is a communication gap between seniors and their physicians around prescription medications. This communication problem is an important quality and safety issue, and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans. Meeting these challenges will require that more attention be devoted to medication management during all clinical encounters.
在2006年1月生效的联邦医疗保险处方药福利计划背景下，理解并改善药物管理质量尤为重要。
确定全国老年人群体中医生与患者关于药物费用和药物依从性对话的普遍性。
横断面调查。
全国65岁及以上社区居住的联邦医疗保险受益人的分层随机样本。
关于不依从和与费用相关的药物换药的医患对话率。
41%的老年人报告服用五种或更多处方药，超过一半的老年人有两名或更多开处方的医生。总体上32%的老年人以及患有三种或更多慢性病的老年人中有24%报告在过去12个月内未与医生讨论过他们所有不同的药物。在报告因副作用或认为无效而漏服或停药的老年人中，27%未与医生讨论过此事。在报告与费用相关的不依从情况的老年人中，39%未与医生讨论过此事。报告与费用相关的不依从情况的老年人中有38%报告换用了价格较低的药物，在多变量模型中，关于药物费用的讨论与这种换药显著相关（优势比[OR]为5.04，95%置信区间[CI]为4.28 - 5.93，P <.001）。
我们表明老年人与其医生在处方药方面存在沟通差距。这种沟通问题是一个重要的质量和安全问题，并且随着医生和患者面临与新的联邦医疗保险处方药计划覆盖范围相关的新挑战而变得更加突出。应对这些挑战将需要在所有临床诊疗过程中更加关注药物管理。
