Department of Emergency Medicine, George Washington University, Washington, DC.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
Ann Emerg Med. 2013 Nov;62(5):475-485. doi: 10.1016/j.annemergmed.2013.04.013. Epub 2013 May 28.
The objective of this study was to evaluate the relationship between self-reported cost-related nonadherence to prescription medications and emergency department (ED) utilization among Medicare beneficiaries. We hypothesized that persons who report cost-related medication nonadherence would have subsequent higher ED use.
We conducted a retrospective cohort study of continuously enrolled Medicare beneficiaries in 2006 and 2007. We used multivariate logistic regression to evaluate the relationship between ED use and cost-related medication nonadherence. Our principal dependent variable was any ED visit within a 364-day period after an interview assessing cost-related medication nonadherence. Our principal independent variables both denoted cost-related medication nonadherence: mild cost-related medication nonadherence, defined as a reduction in dose or a delay in filling medications because of cost; and severe cost-related medication nonadherence, defined as not filling a medication at all because of cost.
Our sample consisted of 7,177 Medicare Current Beneficiary Survey respondents. Approximately 7.5% of respondents reported mild cost-related medication nonadherence only (n=541) and another 8.2% reported severe cost-related medication nonadherence (n=581). Disabled Medicare beneficiaries with severe cost-related medication nonadherence were more likely to have at least 1 ED visit (1.53; 95% confidence interval 1.03 to 2.26) compared with both disabled Medicare beneficiaries without cost-related medication nonadherence and elderly Medicare beneficiaries in all cost-related medication nonadherence categories.
Our results show an association between severe cost-related medication nonadherence and ED use. Disabled beneficiaries younger than 65 years who report severe cost-related medication nonadherence were more likely to have at least 1 ED visit, even when adjusting for other factors that affect utilization.
本研究旨在评估医疗保险受益人群中自我报告的与费用相关的药物不依从与急诊就诊（ED）利用之间的关系。我们假设报告与费用相关的药物不依从的人随后会有更高的 ED 使用。
我们对 2006 年和 2007 年连续入组的医疗保险受益人群进行了回顾性队列研究。我们使用多变量逻辑回归来评估 ED 使用与与费用相关的药物不依从之间的关系。我们的主要因变量是在接受评估与费用相关的药物不依从的访谈后的 364 天内任何 ED 就诊。我们的主要自变量均表示与费用相关的药物不依从：轻度与费用相关的药物不依从，定义为因费用而减少剂量或延迟用药；严重与费用相关的药物不依从，定义为因费用而完全未服用药物。
我们的样本包括 7177 名医疗保险当前受益调查受访者。约 7.5%的受访者仅报告轻度与费用相关的药物不依从（n=541），另有 8.2%的受访者报告严重与费用相关的药物不依从（n=581）。与没有与费用相关的药物不依从的残疾医疗保险受益人和所有与费用相关的药物不依从类别的老年医疗保险受益相比，有严重与费用相关的药物不依从的残疾医疗保险受益更有可能至少有 1 次 ED 就诊（1.53；95%置信区间 1.03 至 2.26）。
我们的结果表明，严重与费用相关的药物不依从与 ED 使用之间存在关联。报告严重与费用相关的药物不依从的年龄在 65 岁以下的残疾受益更有可能至少有 1 次 ED 就诊，即使在调整了其他影响利用率的因素后也是如此。
