Brummel Amanda, Carlson Angeline M
1 Director, Clinical Ambulatory Pharmacy Services, Medication Therapy Management, Fairview Pharmacy Services, Minneapolis, Minnesota.
2 Director of Research, Data Intelligence Consultants, Eden Prairie, Minnesota.
J Manag Care Spec Pharm. 2016 Jan;22(1):56-62. doi: 10.18553/jmcp.2016.22.1.56.
The beneficial clinical effects of medication adherence have been consistently reported across most chronic diseases. Medication nonadherence carries significant economic and clinical burden. Medication therapy management (MTM) services aim to optimize pharmacotherapy and improve medication adherence.
To evaluate the impact of exposure to face-to-face comprehensive medication management (CMM) services on medication adherence across 4 classes of chronic disease medications: oral diabetes medications, statins, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), and beta-blockers.
Pharmacy claims of continuously enrolled employees of a large Midwest integrated health system were retrieved for the period 2007-2011. Retrospective analysis was used to compare medication adherence measured using proportion of days covered (PDC) in employees who received CMM with employees who did not (control group). The pharmacy MTM program used the Patient-Centered Primary Care Collaborative standard of care. The CMM group's index date was the date of the first CMM visit; the non-CMM group's index date was randomly chosen from all therapeutic class-specific prescription claims dates. For each therapeutic class, patients with at least 1 prescription fill in both the measurement period (365 days post-index) and the baseline period (365 days pre-index) were included. The primary outcome measure was the PDC.
The CMM group had consistently higher and statistically significant PDC levels across all the therapeutic classes in the measurement period (P < 0.05) when looking at the unadjusted comparison. In the multivariate models, CMM exposure was associated with higher PDC; the difference between groups was statistically significant in all therapeutic classes except for oral diabetes medications (oral diabetes medications: 0.0403, 95% confidence limits [CL] = -0.0050, 0.0850; statins: 0.0769, 95% CL = 0.0480, 0.1050; ACEIs/ARBs: 0.1083; 95% CL = 0.0710, 0.1450; and beta-blockers: 0.0484; 95% CL = 0.0060, 0.0910). Logistic regression showed that the CMM group had an increased probability of meeting the 80% PDC cut-point for statins (3.36, 95% CL = 0.048, 0.105); ACEIs/ARBs (3.57, 95% CL = 2.35, 5.42); and beta-blockers (2.56, 95% CL = 1.57, 4.18).
Exposure to face-to-face CMM services resulted in improvement of medication adherence. CMM is a powerful practice model that should be encouraged by insurers and health plan administrators to increase rates of medication adherence.
在大多数慢性病中，坚持用药的临床益处已得到一致报道。不坚持用药会带来巨大的经济和临床负担。药物治疗管理（MTM）服务旨在优化药物治疗并提高用药依从性。
评估接受面对面综合药物管理（CMM）服务对四类慢性病药物（口服降糖药、他汀类药物、血管紧张素转换酶抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）以及β受体阻滞剂）用药依从性的影响。
检索了2007年至2011年期间美国中西部一家大型综合医疗系统持续参保员工的药房报销记录。采用回顾性分析比较接受CMM服务的员工（CMM组）和未接受CMM服务的员工（对照组）使用药物覆盖天数比例（PDC）衡量的用药依从性。药房MTM项目采用以患者为中心的初级保健协作护理标准。CMM组的索引日期为首次CMM就诊日期；非CMM组的索引日期从所有治疗类别特定的处方报销日期中随机选择。对于每个治疗类别，纳入在测量期（索引日期后365天）和基线期（索引日期前365天）均至少有1次处方配药的患者。主要结局指标为PDC。
在未调整的比较中，CMM组在测量期内所有治疗类别中的PDC水平始终较高且具有统计学意义（P < 0.05）。在多变量模型中，接受CMM服务与较高的PDC相关；除口服降糖药外，所有治疗类别中两组之间的差异均具有统计学意义（口服降糖药：0.0403，95%置信区间[CL] = -0.0050，0.0850；他汀类药物：0.0769，95% CL = 0.0480，0.1050；ACEI/ARB：0.1083；95% CL = 0.0710，0.1450；β受体阻滞剂：0.0484；95% CL = 0.0060，0.0910）。逻辑回归显示，CMM组达到他汀类药物80% PDC切点的概率增加（3.36，95% CL = 0.048，0.105）；ACEI/ARB（3.57，95% CL = 2.35，5.42）；β受体阻滞剂（2.56，95% CL = 1.57，4.18）。
接受面对面CMM服务可提高用药依从性。CMM是一种强大的实践模式，保险公司和健康计划管理者应鼓励采用以提高用药依从率。
