Veterans Affairs San Diego Healthcare System, San Diego, California; UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California.
Veterans Affairs San Diego Healthcare System, San Diego, California; UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California.
Womens Health Issues. 2014 Mar-Apr;24(2):e237-41. doi: 10.1016/j.whi.2013.12.002. Epub 2014 Feb 16.
There are limited studies available analyzing association between copayment and hormonal contraception adherence. The study was conducted to investigate the association between copayment status and hormonal contraceptive adherence in a female veteran population when stratified by socioeconomic status.
This 4-year, retrospective, cohort study of women Veterans from the Veterans Integrated Service Network 22, a network of Veterans Affairs facilities that includes Southern California and Nevada, included patients who received a new hormonal contraceptive prescription between October 1, 2008, and September 30, 2012. Patients were split into five quintiles (one having the lowest income and five the highest) dependent on zip code-based median annual household income from the 2007-2011 American Community Survey data. Medication possession ratio difference of copayment versus no copayment group for each respective quintile was the primary outcome. Analysis was done using multiple linear regression models.
A total of 3,622 patients met the inclusion criteria and were included in the analysis. Over the entire population, copayment was significantly associated with reduced adherence (-0.034; 95% confidence interval [CI], -0.06 to -0.008). Patients in the highest socioeconomic group, quintile five, had the largest reduction in adherence associated with having a copayment (-0.073; 95% CI, -0.129 to -0.017). Patients in the other four quintiles saw varying levels of decreased adherence respectively, although the differences did not achieve statistical significance.
The association between adherence and copayment status varied by socioeconomic status. Our findings suggest that even affluent patients may be discouraged from adherence when subject to a copayment. If larger studies substantiate these findings, consideration should be given to a policy that exempts women veterans from copayments for hormonal contraceptives.
目前仅有少数研究分析了自付额与激素避孕依从性之间的关系。本研究旨在调查在按社会经济地位分层的女性退伍军人人群中，自付额状况与激素避孕药具依从性之间的关系。
这是一项为期 4 年的回顾性队列研究，纳入了退伍军人整合服务网络 22（Veterans Integrated Service Network 22，一个包含南加州和内华达州的退伍军人事务设施网络）的女性退伍军人，这些患者在 2008 年 10 月 1 日至 2012 年 9 月 30 日期间接受了新的激素避孕处方。患者根据 2007-2011 年美国社区调查数据中基于邮政编码的中位数家庭年收入，分为五组（收入最低的一组和收入最高的一组）。每个组别的自付额与无自付额组之间药物持有率差异是主要结果。使用多元线性回归模型进行分析。
共有 3622 名患者符合纳入标准并纳入分析。在整个人群中，自付额与依从性降低显著相关（-0.034；95%置信区间 [CI]，-0.06 至 -0.008）。在社会经济地位最高的五组患者中，与自付额相关的依从性降低幅度最大（-0.073；95%CI，-0.129 至 -0.017）。其他四组患者的依从性降低程度各不相同，但差异没有达到统计学意义。
依从性与自付额状况之间的关系因社会经济地位而异。我们的研究结果表明，即使是富裕的患者，在面临自付额时，也可能会降低对药物的依从性。如果更大规模的研究证实了这些发现，那么应该考虑制定一项政策，使女性退伍军人免除激素避孕药具的自付额。
