Thorpe Carolyn T, Johnson Heather, Dopp Anna Legreid, Thorpe Joshua M, Ronk Katie, Everett Christine M, Palta Mari, Mott David A, Chewning Betty, Schleiden Loren, Smith Maureen A
Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA 15240-1001, USA; Department of Pharmacy and Therapeutics, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15261, USA.
Department of Medicine, University of Wisconsin, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
Res Social Adm Pharm. 2015 May-Jun;11(3):382-400. doi: 10.1016/j.sapharm.2014.09.002. Epub 2014 Sep 11.
Studies in integrated health systems suggest that patients often accumulate oversupplies of prescribed medications, which is associated with higher costs and hospitalization risk. However, predictors of oversupply are poorly understood, with no studies in Medicare Part D.
The aim of this study was to describe prevalence and predictors of oversupply of antidiabetic, antihypertensive, and antihyperlipidemic medications in adults with diabetes managed by a large, multidisciplinary, academic physician group and enrolled in Medicare Part D or a local private health plan.
This was a retrospective cohort study. Electronic health record data were linked to medical and pharmacy claims and enrollment data from Medicare and a local private payer for 2006-2008 to construct a patient-quarter dataset for patients managed by the physician group. Patients' quarterly refill adherence was calculated using ReComp, a continuous, multiple-interval measure of medication acquisition (CMA), and categorized as <0.80 = Undersupply, 0.80-1.20 = Appropriate Supply, >1.20 = Oversupply. We examined associations of baseline and time-varying predisposing, enabling, and medical need factors to quarterly supply using multinomial logistic regression.
The sample included 2519 adults with diabetes. Relative to patients with private insurance, higher odds of oversupply were observed in patients aged <65 in Medicare (OR = 3.36, 95% CI = 1.61-6.99), patients 65+ in Medicare (OR = 2.51, 95% CI = 1.37-4.60), patients <65 in Medicare/Medicaid (OR = 4.55, 95% CI = 2.33-8.92), and patients 65+ in Medicare/Medicaid (OR = 5.73, 95% CI = 2.89-11.33). Other factors associated with higher odds of oversupply included any 90-day refills during the quarter, psychotic disorder diagnosis, and moderate versus tight glycemic control.
Oversupply was less prevalent than in previous studies of integrated systems, but Medicare Part D enrollees had greater odds of oversupply than privately insured individuals. Future research should examine utilization management practices of Part D versus private health plans that may affect oversupply.
对综合医疗系统的研究表明，患者常常会积累过量的处方药，这与更高的成本和住院风险相关。然而，过量供应的预测因素却鲜为人知，医疗保险D部分（Medicare Part D）尚无相关研究。
本研究旨在描述由一个大型多学科学术医师团队管理并参加医疗保险D部分或当地私人健康保险计划的成年糖尿病患者中，抗糖尿病、抗高血压和抗高血脂药物过量供应的患病率及预测因素。
这是一项回顾性队列研究。将电子健康记录数据与2006 - 2008年医疗保险和当地一家私人支付方的医疗及药房报销数据以及参保数据相链接，为该医师团队管理的患者构建一个患者季度数据集。使用ReComp计算患者的季度续方依从性，ReComp是一种连续的多间隔药物获取量（CMA）测量方法，并将其分类为<0.80 =供应不足，0.80 - 1.20 =供应适当，>1.20 =供应过量。我们使用多项逻辑回归分析基线和随时间变化的易患因素、促成因素和医疗需求因素与季度供应之间的关联。
样本包括2519名成年糖尿病患者。与私人保险患者相比，医疗保险中年龄<65岁的患者（OR = 3.36，95% CI = 1.61 - 6.99）、医疗保险中65岁及以上的患者（OR = 2.51，95% CI = 1.37 - 4.60）、医疗保险/医疗补助中年龄<65岁的患者（OR = 4.55，95% CI = 2.33 - 8.92）以及医疗保险/医疗补助中65岁及以上的患者（OR = 5.73，95% CI = 2.89 - 11.33）出现过量供应的几率更高。与过量供应几率较高相关的其他因素包括该季度有任何90天的续方、精神病诊断以及血糖控制为中度而非严格控制。
与之前对综合系统的研究相比，过量供应的情况不太普遍，但医疗保险D部分的参保者比私人保险个体出现过量供应的几率更高。未来的研究应考察医疗保险D部分与可能影响过量供应的私人健康保险计划的使用管理做法。
