Rood Mark N, Cruz-Knight Wanda, Cunagin James, Zyzanski Stephen J, Werner James J, Mason Mary Jane, Lawson Peter J, Stange Kurt C, Flocke Susan A
Department of Family Medicine, Case Western Reserve University, South Russell Family Practice, Cleveland, OH, USA.
J Fam Pract. 2012 Jul;61(7):E1-7.
Insurance plans periodically change their formularies to enhance medical efficacy and cost savings. Patients face challenges when formulary changes affect their treatment. This study assessed the impact of insurance-driven medication changes on primary care patients and examined implications for patient care.
We mailed questionnaires to a cross-sectional random sample of 1200 adult patients who had visited one of 3 family medicine practices within the past 6 months, asking them to describe problems they had encountered in filling medication prescriptions. We performed descriptive analyses of the frequency and distribution of demographic variables and conditions being treated. Using logistic regression analysis, we identified demographic and health-related variables independently associated with patient-reported problems caused by formulary changes.
Three variables-a greater number of prescription medications taken, younger patient age, and reliance on government insurance-were independently associated with an increased likelihood of encountering a problem filling a medication. Patients who reported an insurance-related issue filling a new or existing prescription over the past year (23%) encountered an average of 3 distinct problems. Patients experienced adverse medical outcomes (41%), decreased satisfaction with the health care system (68%), and problems that burdened the physician practice (83%). Formulary changes involving cardiac/hypertension/lipid and neurologic/psychiatric medications caused the most problems.
Insurance-driven medication changes adversely affect patient care and access to treatment, particularly for patients with government insurance. A better understanding of the negative impact of formulary changes on patient care and indirect health care expenditures should inform formulary change practices in order to minimize cost-shifting and maximize continuity of care.
保险计划会定期更改其药品目录，以提高医疗效果并节省成本。当药品目录变更影响到患者的治疗时，患者会面临挑战。本研究评估了保险驱动的药物变更对初级保健患者的影响，并探讨了对患者护理的影响。
我们向1200名成年患者的横断面随机样本邮寄了问卷，这些患者在过去6个月内曾就诊于3家家庭医学诊所之一，要求他们描述在填写药物处方时遇到的问题。我们对人口统计学变量和所治疗疾病的频率及分布进行了描述性分析。使用逻辑回归分析，我们确定了与患者报告的因药品目录变更导致的问题独立相关的人口统计学和健康相关变量。
三个变量——服用的处方药数量较多、患者年龄较小以及依赖政府保险——与填写药物时遇到问题的可能性增加独立相关。在过去一年中报告在填写新处方或现有处方时遇到与保险相关问题的患者（23%）平均遇到了3个不同的问题。患者经历了不良医疗后果（41%）、对医疗保健系统的满意度下降（68%）以及给医生诊所带来负担的问题（83%）。涉及心脏/高血压/血脂和神经/精神药物的药品目录变更引发的问题最多。
保险驱动的药物变更对患者护理和治疗可及性产生不利影响，尤其是对依赖政府保险的患者。更好地了解药品目录变更对患者护理和间接医疗保健支出的负面影响，应为药品目录变更实践提供参考，以尽量减少成本转移并最大限度地提高护理连续性。
