Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA.
Clinical Outcomes and Analytic Services, Walgreen Co, Deerfield, IL, USA.
J Racial Ethn Health Disparities. 2017 Jun;4(3):462-471. doi: 10.1007/s40615-016-0247-7. Epub 2016 Jun 28.
Adherence to statins is lower in black and Hispanic patients and is linked to racial/ethnic disparities in cardiovascular mortality. Poverty, education, and prescription coverage differentials are typically invoked to explain adherence disparities, but analyses at the level of neighborhoods and their pharmacies may provide additional insights. Among individuals filling new statin prescriptions in a national pharmacy chain (N = 326,171), we compared adherence for patients residing in mostly minority neighborhoods to those living in mainly white areas. In analyses adjusting for patient-level factors associated with poor adherence, including age, insurance, payer, prescription cost, and convenience, patients residing in black and Hispanic neighborhoods had 2-3 weeks less statin therapy over 1 year, a pattern not seen in Asian areas. In black and Hispanic neighborhoods, good adherence was associated with co-pays under $10, the use of 90-day refills, and payers other than Medicaid. Efforts to improve medication adherence for vulnerable populations may benefit from interventions at the level of local pharmacies, as well as medication benefit redesign.
黑人患者和西班牙裔患者遵医嘱服用他汀类药物的情况较低，这与心血管疾病死亡率的种族/民族差异有关。贫困、教育和处方覆盖差异通常被用来解释用药依从性差异，但在社区及其药房层面进行分析可能会提供更多的见解。在全国连锁药店（N=326171）新开他汀类药物处方的患者中，我们比较了居住在以少数族裔为主的社区和以白人为主的社区的患者的用药依从性。在对与用药依从性差相关的患者层面因素（包括年龄、保险、支付方、处方费用和便利性）进行调整的分析中，居住在黑人和西班牙裔社区的患者在 1 年内接受他汀类药物治疗的时间少了 2-3 周，而在亚洲社区则没有这种情况。在黑人和西班牙裔社区，较低的共付额（低于 10 美元）、使用 90 天的续方和非医疗补助支付方与良好的用药依从性相关。为弱势人群改善药物依从性的努力可能会受益于针对当地药店的干预措施，以及药物福利的重新设计。
