医疗保险受益人心力衰竭患者的种族/民族、残疾状况与药物依从性
Race/Ethnicity, disability, and medication adherence among medicare beneficiaries with heart failure.
作者信息
Zhang Yuting, Baik Seo Hyon
机构信息
Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA,
出版信息
J Gen Intern Med. 2014 Apr;29(4):602-7. doi: 10.1007/s11606-013-2692-x. Epub 2013 Dec 24.
BACKGROUND
Recent and national data on adherence to heart failure drugs are limited, particularly among the disabled and some small minority groups, such as Native Americans and Hispanics.
OBJECTIVE
We compare medication adherence among Medicare patients with heart failure, by disability status, race/ethnicity, and income.
DESIGN
Observational study.
SETTING
US Medicare Parts A, B, and D data, 5% random sample, 2007-2009.
PARTICIPANTS
149,893 elderly Medicare beneficiaries and 21,204 disabled non-elderly beneficiaries.
MAIN MEASURES
We examined 5% of Medicare fee-for-service beneficiaries with heart failure in 2007-2009. The main outcome was 1-year adherence to one of three therapeutic classes: β-blockers, diuretics, and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs). Adherence was defined as having prescriptions in possession for ≥ 75% of days.
KEY RESULTS
Among aged beneficiaries, 1-year adherences to at least one heart failure drug were 63%, 57%, 53%, 50%, and 52% for Whites, Asians, Hispanics, Native Americans and Blacks, respectively; among the disabled, 1-year adherence was worse for each group: 57%, 53%, 48%, 44% and 43% respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location and health status. Patterns of adherence were similar among beneficiaries on all three therapeutic classes. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to Whites, OR = 0.61 (95% CI 0.58-0.64) for Hispanics, OR = 0.59 (95% CI 0.57-0.62) for Blacks and OR = 0.57 (95% CI 0.47-0.68) for Native Americans.
CONCLUSION
After the implementation of Medicare Part D, adherence to heart failure drugs remains problematic, especially among disabled and minority beneficiaries, including Native Americans, Blacks, and Hispanics. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.
背景
近期关于心力衰竭药物依从性的全国性数据有限，尤其是在残疾人群体以及一些少数族裔群体中，如美国原住民和西班牙裔。
目的
我们按残疾状况、种族/族裔和收入比较医疗保险中患有心力衰竭的患者的药物依从性。
设计
观察性研究。
背景
美国医疗保险A、B和D部分的数据，2007 - 2009年5%的随机样本。
参与者
149,893名老年医疗保险受益人以及21,204名残疾非老年受益人。
主要测量指标
我们研究了2007 - 2009年5%的按服务收费的医疗保险心力衰竭受益人。主要结果是对三类治疗药物之一的一年依从性：β受体阻滞剂、利尿剂以及血管紧张素转换酶抑制剂（ACEIs）/血管紧张素II受体阻滞剂（ARBs）。依从性定义为在≥75%的天数内持有处方。
关键结果
在老年受益人中，白人、亚裔、西班牙裔、美国原住民和黑人对至少一种心力衰竭药物的一年依从率分别为63%、57%、53%、50%和52%；在残疾人群体中，每组的一年依从性更差：分别为57%、53%、48%、44%和43%。在对年龄、性别、收入、药物覆盖范围、地点和健康状况进行调整后，种族/族裔差异依然存在。在所有三类治疗药物的受益人中，依从模式相似。在药物覆盖接近完全的受益人中，少数族裔相对于白人仍然不太可能依从，西班牙裔的比值比（OR）= 0.61（95%置信区间0.58 - 0.64），黑人的OR = 0.59（95%置信区间0.57 - 0.62），美国原住民的OR = 0.57（95%置信区间0.47 - 0.68）。
结论
医疗保险D部分实施后，心力衰竭药物的依从性仍然存在问题，尤其是在残疾人和少数族裔受益人中，包括美国原住民、黑人和西班牙裔。即使在药物覆盖接近完全的人群中，种族差异仍然存在，这表明仅依靠降低成本的政策无法消除种族差异。
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