密歇根州利用药房索赔数据进行他汀类药物依从性的地理空间分析。
Geospatial analysis of statin adherence using pharmacy claims data in the state of Michigan.
机构信息
University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI 48109-1065.
出版信息
J Manag Care Spec Pharm. 2014 Dec;20(12):1208-15. doi: 10.18553/jmcp.2014.20.12.1208.
BACKGROUND
Research has demonstrated that variation in availability and utilization of health care resources exist on a range of scales, from regions of the United States, hospital referral regions, ZIP codes, and census tracts. Limited research using spatial analyses has found that variation in medication adherence exists across census tracts. Using spatial analysis, researchers may be able to effectively analyze geographically dispersed data to determine whether factors such as sociodemographics, local shared beliefs and attitudes, barriers to access such as availability of prescribers or pharmacies, or others are associated with variations in medication adherence in a defined geographic area.
OBJECTIVES
To (a) demonstrate that medication adherence may be mapped across an entire state using medication possession ratios and (b) determine whether a geographic pattern of adherence to statins could be identified at the ZIP code level for members of a statewide insurer.
METHODS
This study utilized pharmacy claims data from a statewide insurer. Insured statin users were aged greater than 30 years, had at least 1 statin prescription, and were continuously enrolled for the observation year. Patient medication possession ratios (MPR) were derived, which were then aggregated as a mean MPR for each ZIP code. ZIP codes were categorized as higher (MPR greater than 0.80) or lower (MPR less than 0.80) adherence and mapped using Arc GIS, a platform for designing and managing solutions through the application of geographic knowledge. Analysis included a determination of whether the MPRs of higher and lower adherence ZIP codes were significantly different. Hot spot analysis was conducted to identify clustering of higher, midrange, and lower adherent ZIP codes using the GetisORD Gi* Statistic. This test provides z-scores and P values to indicate where features with either high or low values cluster spatially. MPRs for these 3 categories were compared using one-way analysis of variance (ANOVA).
RESULTS
Of 1,154 Michigan ZIP codes, 907 were represented by 212,783 insured statin users. The mean statin MPR by ZIP code was 0.79 ± 0.4. The mean MPR for higher adherent ZIP codes was 0.83 ± 0.03 and 0.76 ± 0.03 for lower adherent ZIP codes (P less than 0.001). Significant clustering of ZIP codes by adherence levels was evident from the hot spot analysis. The mean MPR was 0.84 ± 0.04 for high adherence areas, 0.79 ± 0.03 for midrange areas, and 0.74 ± 0.04 for lower adherent areas (overall P less than 0.001).
CONCLUSIONS
Significant variations in adherence exist across ZIP codes at a state level. Future research is needed to determine locally relevant factors associated with this finding, which may be used to derive locally meaningful interventions.
背景
研究表明，医疗保健资源的可得性和利用情况存在多种规模的差异，从美国的各个地区、医院转诊区域、ZIP 码和普查地段。使用空间分析进行的有限研究发现，在普查地段存在药物依从性的差异。通过空间分析，研究人员可以有效地分析地域分散的数据，以确定社会人口统计学因素、当地共同的信仰和态度、获取药物的障碍（如开处方者或药店的可用性）等因素是否与特定地理区域内的药物依从性变化有关。
目的
（a）证明可以使用药物持有率在整个州范围内绘制药物依从性地图；（b）确定在全州保险公司成员的邮政编码级别上是否可以确定他汀类药物依从性的地理模式。
方法
本研究利用全州保险公司的药房理赔数据。年龄大于 30 岁的保险他汀类药物使用者至少有 1 份他汀类药物处方，并且在观察年度内连续参保。患者药物持有率（MPR）被推导出，然后作为每个邮政编码的平均 MPR 进行汇总。邮政编码分为高（MPR>0.80）和低（MPR<0.80）依从性，并使用 ArcGIS 进行映射，ArcGIS 是一个通过应用地理知识来设计和管理解决方案的平台。分析包括确定高和低依从性邮政编码的 MPR 是否存在显著差异。使用 GetisORD Gi*统计量进行热点分析，以确定高、中、低依从性邮政编码的聚类情况。该检验提供 z 分数和 P 值，以指示具有高值或低值的特征在空间上的聚类位置。使用单因素方差分析（ANOVA）比较这 3 个类别的 MPR。
结果
在 1154 个密歇根邮政编码中，有 907 个由 212783 名参保他汀类药物使用者代表。邮政编码的平均他汀类药物 MPR 为 0.79±0.4。高依从性邮政编码的平均 MPR 为 0.83±0.03，低依从性邮政编码的平均 MPR 为 0.76±0.03（P<0.001）。从热点分析中可以明显看出，邮政编码的依从性水平存在显著聚类。高依从性区域的平均 MPR 为 0.84±0.04，中范围区域的平均 MPR 为 0.79±0.03，低依从性区域的平均 MPR 为 0.74±0.04（总体 P<0.001）。
结论
在州一级，邮政编码之间的依从性存在显著差异。需要进一步研究确定与这一发现相关的局部相关因素，这些因素可能被用于得出具有本地意义的干预措施。
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