Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA.
Value Health. 2010 Jun-Jul;13(4):338-45. doi: 10.1111/j.1524-4733.2009.00679.x. Epub 2010 Jan 8.
Although multiple noncost factors likely influence a patient's propensity to forego treatment in the face of cost pressures, little is known about how patients' sociodemographic characteristics, physical and behavioral health comorbidities, and prescription regimens influence cost-related nonadherence (CRN) to medications. We sought to determine both financial and nonfinancial factors associated with CRN in a nationally representative sample of older adults.
We used a conceptual model developed by Piette and colleagues that describes financial and nonfinancial factors that could increase someone's risk of CRN, including income, comorbidities, and medication regimen complexity. We used data from the 2004 wave of the Health and Retirement Study and the 2005 HRS Prescription Drug Study to examine the influence of factors within each of these domains on measures of CRN (including not filling, stopping, or skipping doses) in a nationally representative sample of Americans age 65+ in 2005.
Of the 3071 respondents who met study criteria, 20% reported some form of CRN in 2005. As in prior studies, indicators of financial stress such as higher out-of-pocket payments for medications and lower net worth were significantly associated with CRN in multivariable analyses. Controlling for these economic pressures, relatively younger respondents (ages 65-74) and depressive symptoms were consistent independent risk factors for CRN.
Noncost factors influenced patients' propensity to forego treatment even in the context of cost concerns. Future research encompassing clinician and health system factors should identify additional determinants of CRN beyond patients' cost pressures.
尽管在面临成本压力时，可能有多种非成本因素会影响患者放弃治疗的倾向，但对于患者的社会人口统计学特征、身体和行为健康合并症以及处方方案如何影响与成本相关的药物不依从（CRN），人们知之甚少。我们旨在确定与老年人群体中具有代表性的全国样本的 CRN 相关的财务和非财务因素。
我们使用 Piette 及其同事开发的概念模型，该模型描述了可能增加某人 CRN 风险的财务和非财务因素，包括收入、合并症和药物治疗方案的复杂性。我们使用来自 2004 年健康与退休研究（Health and Retirement Study）和 2005 年 HRS 处方药研究（HRS Prescription Drug Study）的数据，研究了这些领域内的各种因素对 2005 年全国范围内 65 岁以上美国人 CRN 测量值的影响（包括未填、停止或跳过剂量）。
在符合研究标准的 3071 名受访者中，20%的人在 2005 年报告了某种形式的 CRN。与之前的研究一样，药物自付费用较高和净资产较低等财务压力指标在多变量分析中与 CRN 显著相关。在控制了这些经济压力后，相对较年轻的受访者（65-74 岁）和抑郁症状是 CRN 的独立风险因素。
即使在考虑到成本问题的情况下，非成本因素也会影响患者放弃治疗的倾向。未来涵盖临床医生和卫生系统因素的研究应该确定患者成本压力以外的 CRN 决定因素。
