The University of Mississippi School of Pharmacy, University, Mississippi 38677, USA.
Clin Ther. 2009 Oct;31(10):2178-88; discussion 2150-1. doi: 10.1016/j.clinthera.2009.10.002.
This study examined the prevalence of nonadherence with oral hypoglycemic agents, antihypertensive drugs (angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin II receptor blockers [ARBs]), and statin medications among Medicare Part D enrollees with diabetes and analyzed the potential demographic and clinical factors that predict medication nonadherence.
This was a retrospective cohort study of Medicare Part D enrollees with diabetes from 6 states (Alabama, California, Florida, Mississippi, New York, and Ohio). Adherence was calculated as the proportion of days covered (PDC; number of days with medication on hand/number of days in the specified time interval). A PDC was derived for each of the 3 categories of medications for patients who had at least 1 claim for the same class of medication. A comorbidity measure was created for each beneficiary using the Deyo-adapted Charlson Comorbidity Index (CCI). Associations between nonadherence and patient characteristics including age, sex, race/ethnicity, and Deyo-adapted CCI were examined. Logistic regression models were constructed to identify predictors of nonadherence.
The study included 1,888,682 patients with diabetes. The mean (SD) age was 71.6 (11.6) years, and 59.5% (1,123,220/1,888,682) were female. A total of 66.4% (1,254,538/1,888,682) were white, 16.3% (308,158/1,888,682) were black, and 7.8% (147,498/1,888,682) were Hispanic. Estimated rates of non-adherence for oral hypoglycemic agents, ACEIs/ARBs, and statins were 35.1% (386,666/1,101,533), 41.8% (449,561/1,075,285), and 46.4% (447,106/962,877), respectively. In unadjusted analyses, patients aged <65 years, women, black or Hispanic patients, and patients with higher Deyo-adapted CCI were more likely to be nonadherent to all 3 classes of medications. The results were consistent in multivariate analyses, and all results were statistically significant at P < 0.001.
In this study of Medicare Part D enrollees with diabetes, patients aged <65 years, women, black or Hispanic patients, and those with higher comorbidity scores were more likely to be nonadherent to medications. Interventions should be developed to improve medication adherence among these subgroups so that patients can achieve the full benefits of prescribed pharmacologic therapies.
本研究调查了医疗保险 D 部分中患有糖尿病的患者口服降糖药、抗高血压药物（血管紧张素转换酶抑制剂[ACEI]和血管紧张素 II 受体阻滞剂[ARB]）和他汀类药物的不依从率，并分析了潜在的预测药物不依从的人口统计学和临床因素。
这是一项对来自 6 个州（阿拉巴马州、加利福尼亚州、佛罗里达州、密西西比州、纽约州和俄亥俄州）的医疗保险 D 部分中患有糖尿病的患者进行的回顾性队列研究。依从性通过比例天数覆盖（PDC；手头药物的天数/指定时间间隔内的天数）来计算。对于每种药物类别，至少有 1 种相同类别的药物索赔的每位患者，均得出了 PDC。为每位受益人的合并症情况使用 Deyo 改编的 Charlson 合并症指数（CCI）进行了测量。研究人员对不依从与患者特征（包括年龄、性别、种族/民族和 Deyo 改编的 CCI）之间的关系进行了研究。使用逻辑回归模型确定不依从的预测因素。
本研究共纳入了 1888682 名患有糖尿病的患者。患者的平均（标准差）年龄为 71.6（11.6）岁，59.5%（1123220/1888682）为女性。共有 66.4%（1254538/1888682）为白人，16.3%（308158/1888682）为黑人，7.8%（147498/1888682）为西班牙裔。口服降糖药、ACEI/ARB 和他汀类药物的不依从率估计值分别为 35.1%（386666/1101533）、41.8%（449561/1075285）和 46.4%（447106/962877）。在未调整的分析中，年龄<65 岁、女性、黑人和西班牙裔患者以及合并症评分较高的患者更有可能不依从所有 3 类药物。在多变量分析中，结果一致，且所有结果在 P<0.001 时均具有统计学意义。
在这项针对医疗保险 D 部分中患有糖尿病的患者的研究中，年龄<65 岁、女性、黑人和西班牙裔患者以及合并症评分较高的患者更有可能不依从药物治疗。应制定干预措施来提高这些亚组人群的药物依从性，以使患者能够充分受益于处方药物治疗。
