Choe Hae Mi, Stevenson James G, Streetman Daniel S, Heisler Michele, Sandiford Connie J, Piette John D
College of Pharmacy, University of Michigan, and the University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA.
Am J Manag Care. 2007 Jun;13(6 Part 1):298-304.
To examine willingness to participate in a pill-splitting program and the impact of pill splitting on patients' adherence and lipid control.
Nested randomized trial.
A total of 200 patients who used statins and were candidates for a pill-splitting regimen were identified from a large university-based health plan. Sixty-three percent of study participants were female, 41% were nonwhite, and 94% had at least some college education. Patients were surveyed regarding their willingness to split pills, and 111 consented to participate in a 6-month trial in which half were randomized to receive a financial incentive to split pills: a 50% reduction in their per-refill copayment. Data on patients' statin refills and lipid control were obtained from billing and medical records.
Compared with patients unwilling to participate in the program, those agreeing to split pills were more likely to be female and white. After 6 months, most patients in the trial (89%) were willing to continue pill splitting for a 50% copayment reduction. Patients reported few problems with pill splitting and had no noticeable change in their adherence. The financial-incentive group and the control group did not differ significantly with respect to their low-density lipoprotein cholesterol levels after pill splitting: -2.0 mg/dL and -1.2 mg/dL, respectively.
Most patients indicated that at least a 50% copayment reduction would be required to enroll in a pill-splitting program after the study ended. However, in this relatively educated population, financial incentives did not influence patients' adherence, satisfaction, or health outcomes.
研究参与药片分割计划的意愿以及药片分割对患者依从性和血脂控制的影响。
嵌套随机试验。
从一个大型的基于大学的健康计划中识别出总共200名使用他汀类药物且适合采用药片分割方案的患者。63%的研究参与者为女性，41%为非白人，94%至少接受过一些大学教育。对患者进行了关于他们分割药片意愿的调查，111人同意参与为期6个月的试验，其中一半被随机分配接受分割药片的经济激励：每次重新配药的自付费用降低50%。从计费和医疗记录中获取患者他汀类药物重新配药和血脂控制的数据。
与不愿参与该计划的患者相比，同意分割药片的患者更可能是女性和白人。6个月后，试验中的大多数患者（89%）愿意为了自付费用降低50%而继续进行药片分割。患者报告药片分割几乎没有问题，并且他们的依从性没有明显变化。药片分割后，经济激励组和对照组的低密度脂蛋白胆固醇水平没有显著差异，分别为-2.0mg/dL和-1.2mg/dL。
大多数患者表示，在研究结束后，至少自付费用降低50%才会参与药片分割计划。然而，在这个受教育程度相对较高的人群中，经济激励并未影响患者的依从性、满意度或健康结果。
