Ross Alexander, Jami Humaira, Young Heather A, Katz Richard
The George Washington University, Washington, DC, USA.
J Prim Care Community Health. 2013 Oct;4(4):240-4. doi: 10.1177/2150131913486481. Epub 2013 Apr 25.
Medication nonadherence is associated with higher cost of care and poor outcomes. Medication refill consolidation (synchronization of refill dates for patients on multiple drugs) is an important component of regimen complexity. We presumed that Medicaid patients with a 30-day medication supply limit would have significant difficulty with refill consolidation. We evaluated regimen complexity and refill consolidation in relation to medication adherence in the Medicaid population.
A survey was administered to 50 Medicaid patients taking 2 or more daily medications in the outpatient setting. The survey included demographics, 13 items related to medication and pharmacy history, and 10 items related to medication regimen complexity and refill consolidation. Chi-square analysis was used to assess the relationship between adherence and missed medication doses due to regimen complexity. Wilcoxon rank sum test was used to determine association between total number of prescribing providers and number of daily medications with various aspects of regimen complexity.
52% were required to go to the pharmacy more than once per month to keep all of their medications filled and 46% missed a day or more of medication because their medications must be refilled on different dates. Those who missed a day or more of medication because of need to refill prescriptions on different days had higher number of prescriptions (P = .03) and higher number of prescribers (P = .03).
Medicaid patients had low medication adherence in the context of high regimen complexity and poor refill consolidation. This population would benefit from interventions focused on improving synchronization of medication refills.
药物治疗依从性差与更高的护理成本和不良预后相关。药物重新配药整合（为服用多种药物的患者同步重新配药日期）是治疗方案复杂性的一个重要组成部分。我们推测，有30天药物供应限制的医疗补助患者在重新配药整合方面会有很大困难。我们评估了医疗补助人群中治疗方案复杂性和重新配药整合与药物治疗依从性的关系。
对50名在门诊服用2种或更多种每日药物的医疗补助患者进行了一项调查。该调查包括人口统计学信息、13项与用药和药房历史相关的项目，以及10项与用药方案复杂性和重新配药整合相关的项目。采用卡方分析来评估依从性与因治疗方案复杂性导致的漏服药物剂量之间的关系。采用Wilcoxon秩和检验来确定开处方医生总数和每日用药数量与治疗方案复杂性各个方面之间的关联。
52%的患者每月需要去药房不止一次以确保所有药物都有供应，46%的患者漏服了一天或更多天的药物，因为他们的药物必须在不同日期重新配药。那些因需要在不同日期重新配药而漏服一天或更多天药物的患者有更多的处方数量（P = 0.03）和更多的开处方医生数量（P = 0.03）。
在治疗方案复杂性高和重新配药整合差的情况下，医疗补助患者的药物治疗依从性较低。这一人群将受益于专注于改善药物重新配药同步性的干预措施。
