Wei Yu-Jung, Palumbo Francis B, Simoni-Wastila Linda, Shulman Lisa M, Stuart Bruce, Beardsley Robert, Brown Clayton
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Parkinsonism Relat Disord. 2015 Jan;21(1):36-41. doi: 10.1016/j.parkreldis.2014.10.021. Epub 2014 Oct 31.
To examine 1) the effect of prior antiparkinson drug (APD) nonadherence on subsequent APD regimen modifications; and 2) the influence of modifications on healthcare utilization and costs by patients with Parkinson's disease (PD).
This retrospective cohort study included 7052 PD patients with ≥2 APD prescriptions who initiated a modification of APD regimens in 2007. Modification was assessed as changing from one APD to another and/or adding a new APD to an existing regimen. Nonadherence was measured using Medication Possession Ratio <0.8. Discrete-time survival analyses were used to estimate the effect of prior nonadherent behavior on initiating APD modifications. Generalized linear models were used to estimate the effect of initiating medication modifications on subsequent 3-month medical use and costs.
Initiation of APD modifications in any given month was higher among patients who were nonadherent to APDs in the preceding month (adjusted hazard ratio [HR] = 1.23), compared to their adherent counterparts. Modifications significantly predicted higher risk of all-cause and PD-related hospitalizations (adjusted relative risk [RR] = 1.22 and 1.83, respectively), home health agency utilization (RR = 1.18 and 1.52), and use of physician services (RR = 1.14 and 1.41), as well as higher total all-cause healthcare expenditures (mean = $1064) in any given 3-month interval.
Prior nonadherence to APDs might influence initiation of APD modification. APD modifications were associated with increased health care utilization and expenditures, with the caveats that indications of modifications and disease severity may still play roles. Prescribers should consider patients' medication adherence when changing APD regimens to lower the costs of medical services.
1）研究既往抗帕金森病药物（APD）不依从对后续APD治疗方案调整的影响；2）研究调整对帕金森病（PD）患者医疗服务利用和费用的影响。
这项回顾性队列研究纳入了7052例有≥2次APD处方且在2007年开始调整APD治疗方案的PD患者。治疗方案调整的评估标准为从一种APD更换为另一种APD和/或在现有治疗方案中添加新的APD。使用药物持有率<0.8来衡量不依从情况。采用离散时间生存分析来估计既往不依从行为对启动APD调整的影响。使用广义线性模型来估计启动药物调整对后续3个月医疗使用和费用的影响。
与依从的患者相比，前一个月不依从APD的患者在任何给定月份启动APD调整的比例更高（调整后风险比[HR]=1.23）。调整显著预测了全因和PD相关住院的更高风险（调整后相对风险[RR]分别为1.22和1.83）、家庭健康机构服务的使用（RR=1.18和1.52）以及医生服务的使用（RR=1.14和1.41），以及在任何给定的3个月期间更高的全因医疗总支出（平均=$1064）。
既往不依从APD可能会影响APD调整的启动。APD调整与医疗服务利用和支出增加相关，但需注意调整的指征和疾病严重程度可能仍起作用。在更改APD治疗方案时，处方医生应考虑患者的药物依从性，以降低医疗服务成本。
