Doshi Jalpa A, Lim Raymond, Li Pengxiang, Young Peinie P, Lawnicki Victor F, Troxel Andrea B, Volpp Kevin G
Economic Evaluations Unit, Center for Evidence-based Practice, Director, Value-based Insurance Design Initiatives, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, 1223 Blockley Hall, Philadelphia, PA 19104. E-mail:
Am J Manag Care. 2017 Feb;23(2):98-104.
Medication adherence is often suboptimal, especially among patients on multiple chronic medications. We examined the association between synchronized medication refill schedules-which typically reduce organizational effort and logistical demands-and adherence.
Retrospective study among patients enrolled in Medicare Advantage prescription drug plans.
We used 2012 pharmacy, medical, and enrollment data linked with consumer meta-data for Medicare patients filling 2 or more maintenance prescriptions for antihypertensives, lipid-lowering agents, antidiabetic agents, antidepressants, and/or antiosteoporotic agents. Medication adherence for the year was measured using the proportion of days covered (PDC) at the drug class level. Patients were deemed adherent if drug class PDC was ≥0.80. Outcomes were compared between 1:1 propensity score-matched patients on synchronized versus nonsynchronized refill schedules for maintenance medications.
The synchronized refill group showed better adherence than the control group, although the magnitude of effects varied by drug class and specific outcome measure. Mean PDC scores ranged from 0.02 higher for antihypertensives to 0.07 higher for antidepressants in the synchronized refill group relative to the control group (P <.01). Further, compared with the control group, a larger proportion of synchronized refill group members were deemed adherent, ranging from 6 percentage points higher for antihypertensives to 15 percentage points higher for lipid-lowering agents (P <.01). Differences between the synchronized and control groups were larger among exclusive users of retail versus mail order pharmacies for maintenance medications.
Synchronized medication refill schedules were associated with better medication adherence, particularly for patients filling maintenance medications exclusively at retail pharmacies.
药物依从性往往不理想，尤其是在服用多种慢性药物的患者中。我们研究了同步药物 refill 计划（通常可减少组织工作和后勤需求）与依从性之间的关联。
对参加医疗保险优势处方药计划的患者进行回顾性研究。
我们使用了 2012 年药房、医疗和参保数据，并将其与医疗保险患者的消费者元数据相链接，这些患者正在服用 2 种或更多种用于抗高血压药、降脂药、抗糖尿病药、抗抑郁药和/或抗骨质疏松药的维持性处方。使用药物类别水平的覆盖天数比例（PDC）来衡量该年度的药物依从性。如果药物类别 PDC≥0.80，则患者被视为依从。对维持性药物采用同步与非同步 refill 计划的 1:1 倾向评分匹配患者之间比较结果。
同步 refill 组的依从性优于对照组，尽管效果大小因药物类别和具体结局指标而异。相对于对照组，同步 refill 组中抗高血压药的平均 PDC 得分高 0.02，抗抑郁药高 0.07（P<.01）。此外，与对照组相比，同步 refill 组中被视为依从的成员比例更高，抗高血压药高 6 个百分点，降脂药高 15 个百分点（P<.01）。在维持性药物的零售药店独家用户与邮购药店独家用户之间，同步组与对照组的差异更大。
同步药物 refill 计划与更好的药物依从性相关，特别是对于仅在零售药店购买维持性药物的患者。
