Savitz Samuel T, Stearns Sally C, Zhou Lei, Thudium Emily, Alburikan Khalid A, Tran Richard, Rodgers Jo E
*Department of Health Policy & Management †Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill ‡UNC Eshelman School of Pharmacy, Chapel Hill, NC §College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Med Care. 2017 May;55(5):500-505. doi: 10.1097/MLR.0000000000000701.
Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence.
We matched Part D claims for 6 common medications to medications brought to a study visit in 2011-2013 for the Atherosclerosis Risk in Communities study. The combined data consisted of 3027 medication events (claims, medications possessed, or both) for 2099 Atherosclerosis Risk in Communities study participants. Multinomial logistic regression estimated the association of concordance (visit only, Part D only, or both) with self-reported medication adherence while controlling for sociodemographic characteristics, veteran status, and availability under Generic Drug Discount Programs.
Relative to participants with high adherence, medication events for participants with low adherence were approximately 25 percentage points less likely to match and more likely to be visit only (P<0.001). The results were similar but smaller in magnitude (approximately 2-3 percentage points) for participants with medium adherence. Compared with females, medication events for male veterans were approximately 11 percentage points less likely to match and more likely to be visit only. Events for medications available through Generic Drug Discount Programs were 3 percentage points more likely to be visit only.
Part D claims were substantially less likely to be concordant with medications possessed at study visit for participants with low self-reported adherence. This result supports the construction of adherence proxies such as proportion days covered using Part D claims.
医疗保险D部分的报销记录显示了所购买的药物，但未完全依从治疗的患者可能会在规定的用药间隔之外延长处方药物的使用时间。本研究评估了D部分报销记录与研究访视时的药物持有情况之间的一致性，以及与自我报告的药物依从性之间的关系。
我们将2011 - 2013年社区动脉粥样硬化风险研究中6种常用药物的D部分报销记录与研究访视时携带的药物进行匹配。合并后的数据包括2099名社区动脉粥样硬化风险研究参与者的3027次用药事件（报销记录、持有药物或两者皆有）。多项逻辑回归分析在控制社会人口统计学特征、退伍军人身份以及通用药物折扣计划下的可获得性的同时，估计了一致性（仅访视时、仅D部分报销记录或两者皆有）与自我报告的药物依从性之间的关联。
与高依从性参与者相比，低依从性参与者的用药事件匹配的可能性低约25个百分点，且更有可能仅为访视时的情况（P<0.001）。中等依从性参与者的结果相似，但幅度较小（约2 - 3个百分点）。与女性相比，男性退伍军人的用药事件匹配的可能性低约11个百分点，且更有可能仅为访视时的情况。通过通用药物折扣计划可获得的药物的用药事件仅为访视时情况的可能性高3个百分点。
对于自我报告依从性低的参与者，D部分报销记录与研究访视时持有的药物之间的一致性显著降低。这一结果支持构建依从性替代指标，如使用D部分报销记录计算的覆盖天数比例。
