United Health Group, 15 Runyon St, Hillsborough, NJ 08844, USA.
Am J Manag Care. 2010 Feb 1;16(2):e43-50.
To evaluate the impact of enrolling in a consumer-driven health plan (CDHP) on adherence to maintenance drugs.
Two-year retrospective cohort study.
Consumer-driven health plan patients were enrolled in a traditional managed care plan in 2005 (pre-year) and a full-replacement CDHP in 2006 (post-year). Traditional-plan patients voluntarily enrolled in a traditional plan in both years. Adherence measures included (1) post-year continuation rate among continuous users, (2) time to refill the first prescription in the post-year, (3) change in the compliance rate from the pre- to the post-year, and (4) total days with continuous drug supply in the post-year. Analysis was conducted on 8 drug classes.
The CDHP patients had a slightly higher illness burden and used more medication in the pre-year. The continuation rate was relatively high for all drug classes, although the CDHP cohort had a lower probability of continuing cardiac and cholesterol drugs. Consumer-driven health plan patients took slightly longer on average to refill their first prescription in the post-year for cardiac, hypertension, cholesterol, and thyroid drugs. The compliance rate dropped over time in both cohorts, but the reduction was bigger among CDHP patients for 3 drug classes (adjusted ratio of the odds ratios was 0.77, 0.78, and 0.69 for asthma, cardiac, and cholesterol drugs, respectively). The CDHP patients also terminated their continuous drug supply 21 days earlier for epilepsy drugs and 27 days earlier for cholesterol drugs.
Adherence was lower for a few drug classes among CDHP patients.
评估参加消费者驱动的健康计划（CDHP）对维持药物依从性的影响。
为期两年的回顾性队列研究。
2005 年（前一年），消费者驱动的健康计划患者参加了一项传统的管理式医疗计划，2006 年（后一年）参加了一项全额替代的 CDHP。传统计划的患者在这两年都自愿参加了传统计划。依从性测量包括（1）连续使用者在后一年的持续用药率，（2）在后一年首次处方的续药时间，（3）从前一年到后一年的遵医嘱率的变化，以及（4）在后一年中连续药物供应的总天数。对 8 种药物类别进行了分析。
CDHP 患者的疾病负担略高，在前一年使用的药物也更多。所有药物类别的续药率都相对较高，尽管 CDHP 队列继续使用心脏和胆固醇药物的可能性较低。与传统计划患者相比，CDHP 患者在后一年平均需要更长时间来续药，用于心脏、高血压、胆固醇和甲状腺药物。在两个队列中，遵医嘱率随时间下降，但 CDHP 患者的下降幅度更大，分别为 3 种药物类别（哮喘、心脏和胆固醇药物的调整比值比分别为 0.77、0.78 和 0.69）。CDHP 患者还提前 21 天停止了癫痫药物的连续药物供应，提前 27 天停止了胆固醇药物的连续药物供应。
对于一些药物类别，CDHP 患者的依从性较低。
