West Joyce C, Wilk Joshua E, Muszynski Irvin L, Rae Donald S, Rubio-Stipec Maritza, Alter Carol L, Narrow William E, Regier Darrel A
American Psychiatric Institute for Research and Education, American Psychiatric Association, Practice Research Network, 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209, USA.
Am J Psychiatry. 2007 May;164(5):789-96. doi: 10.1176/ajp.2007.164.5.789.
This study attempted to systematically assess the experiences of Medicare and Medicaid "dual-eligible" psychiatric patients, including evaluating patients' access to medications and the administrative functioning of the program, during the first 4 months of the Medicare Part D prescription drug benefit.
Psychiatrists (N=5,833) were randomly selected from the American Medical Association's Physicians Masterfile. After exclusion of those not practicing and with undeliverable addresses, 64% responded; 35% met study eligibility criteria of treating at least one dual-eligible patient during their last typical workweek and reported clinically detailed information on one systematically selected patient.
A total of 53.4% had at least one medication access problem to report between Jan. 1 and April 30, 2006. Although 9.7% experienced improved medication access, 22.3% discontinued or temporarily stopped taking medication because of prescription drug coverage or management issues, and 18.3% were previously stable but were required to switch medications. Among those with medication access problems, 27.3% experienced a significant adverse clinical event; 19.8% had an emergency room visit. Most drug plan features studied, including preferred drug/formulary lists, prior authorization, medication dosing/number limits, "fail-first" protocols, and requirements to switch to generics, were associated with significantly higher rates of medication access problems.
The findings indicate consequential medication access problems for psychiatric patients during the implementation of Medicare Part D. Although Centers for Medicare and Medicaid Services policies were enacted to ensure access to protected classes of psychopharmacologic medications, the high rates of medication access problems observed indicate further refinement of these policies is needed.
本研究试图系统评估医疗保险和医疗补助“双重资格”精神病患者的经历，包括在医疗保险D部分处方药福利实施的前4个月里，评估患者获得药物的情况以及该项目的管理运作情况。
从美国医学协会的医师主档案中随机选取精神科医生（N = 5833名）。在排除那些不执业以及地址无法送达的医生后，64%的医生做出了回应；35%的医生符合研究资格标准，即在其最后一个典型工作周内至少治疗过一名双重资格患者，并报告了关于一名系统选取患者的临床详细信息。
在2006年1月1日至4月30日期间，共有53.4%的医生报告至少有一名患者存在药物获取问题。虽然9.7%的患者药物获取情况有所改善，但22.3%的患者因处方药覆盖范围或管理问题而停药或暂时停止服药，18.3%的患者之前病情稳定但被要求更换药物。在有药物获取问题的患者中，27.3%经历了严重的不良临床事件；19.8%的患者去过急诊室。研究的大多数药物计划特征，包括首选药物/处方集清单、预先授权、药物剂量/数量限制、“先失败”方案以及改用仿制药的要求，都与药物获取问题的发生率显著较高相关。
研究结果表明，在医疗保险D部分实施期间，精神病患者存在严重的药物获取问题。尽管医疗保险和医疗补助服务中心制定了政策以确保获得受保护类别的精神药物，但观察到的高药物获取问题发生率表明这些政策需要进一步完善。
