Richardson Kathryn, Kenny Rose Anne, Bennett Kathleen
The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland; Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
Pharmacoepidemiol Drug Saf. 2014 Jun;23(6):656-65. doi: 10.1002/pds.3590. Epub 2014 Feb 20.
Differing healthcare access has implications for public health. In Ireland, eligibility for free public health care is means tested. Here, we examine the association between healthcare access and polypharmacy while accounting for underlying socio-economic and health status differences.
Self-reported regular medication use, history of diagnosed health conditions, disability, socio-demographics, and objective measures of depression and anxiety for adults aged 50-69 years (n = 5796) were ascertained from the population-representative Irish Longitudinal Study on Ageing. Objective measures of frailty, cognition, hypertension, and body mass index were also assessed for 4241 participants. The associations between free healthcare access and polypharmacy and use of 15 medication classes were estimated using multivariable modified Poisson regression, adjustment for the propensity score, and inverse probability of treatment weighting by the propensity score.
Polypharmacy was reported by 22% and 7% of the 1932 and 3864 participants with and without public healthcare coverage. Public patients had a 21-38% greater risk of polypharmacy depending on the method used to account for confounding. Results were less robust using propensity score weighting. There was evidence that classes of cardiovascular drugs, drugs for acid-related disorders, and analgesics were used more commonly in public patients. Associations were mostly unaffected after also accounting for objective health measures but were significantly attenuated after accounting for frequency of healthcare visits.
Publically funded health care in Ireland leads to greater medication use in people aged 50-69 years. This may reflect over-prescribing to public patients or restricted use among those who pay out of pocket.
不同的医疗保健可及性对公众健康有影响。在爱尔兰，免费公共医疗保健的资格是根据收入情况调查的。在此，我们在考虑潜在的社会经济和健康状况差异的同时，研究医疗保健可及性与多重用药之间的关联。
从具有人口代表性的爱尔兰老龄化纵向研究中确定了50 - 69岁成年人（n = 5796）的自我报告的常规用药情况、确诊的健康状况史、残疾情况、社会人口统计学特征以及抑郁和焦虑的客观测量指标。还对4241名参与者进行了虚弱、认知、高血压和体重指数的客观测量。使用多变量修正泊松回归、倾向得分调整以及倾向得分的逆概率治疗加权法，估计了免费医疗保健可及性与多重用药以及15类药物使用之间的关联。
在1932名有公共医疗保健覆盖和3864名无公共医疗保健覆盖的参与者中，分别有22%和7%的人报告存在多重用药情况。根据用于解释混杂因素的方法，公共医疗患者发生多重用药的风险高21% - 38%。使用倾向得分加权时结果不太稳健。有证据表明，心血管药物、治疗酸相关疾病的药物和镇痛药在公共医疗患者中使用更为普遍。在考虑客观健康指标后，关联大多未受影响，但在考虑医疗就诊频率后，关联显著减弱。
爱尔兰的公共资助医疗保健导致50 - 69岁人群用药更多。这可能反映了对公共医疗患者的过度开药或自费患者用药受限。
