艾滋病药物援助计划中可改变心血管风险因素的处方药覆盖范围存在州差异。
State variation in AIDS drug assistance program prescription drug coverage for modifiable cardiovascular risk factors.
机构信息
Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA.
出版信息
J Gen Intern Med. 2011 Dec;26(12):1426-33. doi: 10.1007/s11606-011-1807-5. Epub 2011 Aug 12.
BACKGROUND
In the United States, mortality from cardiovascular disease has become increasingly common among HIV-infected persons. One-third of HIV-infected persons in care may rely on state-run AIDS Drug Assistance Programs (ADAPs) for cardiovascular disease-related prescription drugs. There is no federal mandate regarding ADAP coverage for non-HIV medications.
OBJECTIVE
To assess the consistency of ADAP coverage for type 2 diabetes, hypertension, hyperlipidemia, and smoking cessation using clinical guidelines as the standard of care.
DESIGN
Cross-sectional survey of 53 state and territorial ADAP formularies.
MAIN MEASURES
ADAPs covering all first-line drugs for a cardiovascular risk factor were categorized as "consistent" with guidelines, while ADAPs covering at least one first-line drug, but not all, for a cardiovascular risk factor, were categorized as "partially consistent". ADAPs without coverage were categorized as "no coverage".
KEY RESULTS
Of 53 ADAPs, four (7.5%) provided coverage consistent with guidelines (coverage for all first-line drugs) for all four cardiovascular risk factors. Thirteen (24.5%) provided no coverage for all four risk factors. Thirty-six (68%) provided at least partially consistent coverage for at least one surveyed risk factor. State ADAPs provided coverage consistent with guidelines most frequently for type 2 diabetes (28%), followed by hypertension (25%), hyperlipidemia (15%) and smoking cessation (8%). Statins (66%) were most commonly covered and nicotine replacement therapies (9%) least often. Many ADAPs provided no first-line treatment coverage for hypertension (60%), type 2 diabetes (51%), smoking cessation (45%), and hyperlipidemia (32%).
CONCLUSIONS
Consistency of ADAP coverage with guidelines for the surveyed cardiovascular risk factors varies widely. Given the increasing lifespan of HIV-infected persons and restricted ADAP budgets, we recommend ADAP coverage be consistent with guidelines for cardiovascular risk factors.
背景
在美国，心血管疾病导致的死亡率在感染艾滋病毒的人群中越来越常见。在接受治疗的艾滋病毒感染者中，有三分之一可能依靠州立艾滋病药物援助计划（ADAP）获得与心血管疾病相关的处方药。对于非艾滋病毒药物，ADAP 的覆盖范围没有联邦授权。
目的
根据临床指南作为护理标准，评估 ADAP 对 2 型糖尿病、高血压、高血脂和戒烟的覆盖范围的一致性。
设计
对 53 个州和地区 ADAP 处方集的横断面调查。
主要措施
将涵盖心血管风险因素所有一线药物的 ADAP 归类为与指南一致，而涵盖心血管风险因素至少一种一线药物但并非全部的 ADAP 归类为部分一致。没有覆盖的 ADAP 归类为没有覆盖。
主要结果
在 53 个 ADAP 中，有 4 个（7.5%）为所有四个心血管风险因素提供了与指南一致的覆盖（涵盖所有一线药物）。有 13 个（24.5%）对所有四个风险因素均未提供覆盖。有 36 个（68%）为至少一个调查风险因素提供了至少部分一致的覆盖。州 ADAP 最常为 2 型糖尿病（28%）、高血压（25%）、高血脂（15%）和戒烟（8%）提供与指南一致的覆盖。他汀类药物（66%）最常被覆盖，尼古丁替代疗法（9%）最不常被覆盖。许多 ADAP 对高血压（60%）、2 型糖尿病（51%）、戒烟（45%）和高血脂（32%）没有提供一线治疗覆盖。
结论
ADAP 对所调查心血管风险因素的覆盖范围与指南的一致性差异很大。鉴于艾滋病毒感染者的预期寿命延长和 ADAP 预算有限，我们建议 ADAP 对心血管风险因素的覆盖范围应与指南一致。
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