Feng Xue, Tan Xi, Riley Brittany, Zheng Tianyu, Bias Thomas K, Becker James B, Sambamoorthi Usha
1 West Virginia University, Morgantown, WV, USA.
2 Marshall University, Huntington, WV, USA.
Ann Pharmacother. 2017 Nov;51(11):981-989. doi: 10.1177/1060028017717017. Epub 2017 Jun 21.
West Virginia (WV) residents are at high risk for polypharmacy given its considerable chronic disease burdens.
To evaluate the prevalence, correlates, outcomes, and geographic variations of polypharmacy among WV Medicaid beneficiaries.
In this cross-sectional study, we analyzed 2009-2010 WV Medicaid fee-for-service (FFS) claims data for adults aged 18-64 (N=37,570). We defined polypharmacy as simultaneous use of drugs from five or more different drug classes on a daily basis for at least 60 consecutive days in one year. Multilevel logistic regression was used to explore the individual- and county-level factors associated with polypharmacy. Its relationship with healthcare utilization was assessed using negative binomial regression and logistic regression. The univariate local indicators of spatial association method was applied to explore spatial patterns of polypharmacy in WV.
The prevalence of polypharmacy among WV Medicaid beneficiaries was 44.6%. High-high clusters of polypharmacy were identified in southern WV, indicating counties with above-average prevalence surrounded by counties with above-average prevalence. Polypharmacy was associated with being older, female, eligible for Medicaid due to cash assistance or medical eligibility, having any chronic conditions or more chronic conditions, and living in a county with lower levels of education. Polypharmacy was associated with more hospitalizations, emergency department visits, and outpatient visits, as well as higher non-drug medical expenditures.
Polypharmacy was prevalent among WV Medicaid beneficiaries and was associated with substantial healthcare utilization and expenditures. The clustering of high prevalence of polypharmacy in southern WV may suggest targeted strategies to reduce polypharmacy burden in these areas.
鉴于西弗吉尼亚州（WV）居民患有相当多的慢性病，他们面临多重用药的高风险。
评估WV医疗补助受益人群中多重用药的患病率、相关因素、后果及地理差异。
在这项横断面研究中，我们分析了2009 - 2010年WV医疗补助按服务收费（FFS）的18 - 64岁成年人（N = 37,570）的理赔数据。我们将多重用药定义为在一年中连续至少60天每天同时使用来自五种或更多不同药物类别的药物。采用多水平逻辑回归来探究与多重用药相关的个体和县级因素。使用负二项回归和逻辑回归评估其与医疗保健利用的关系。应用单变量局部空间关联指标法来探究WV多重用药的空间模式。
WV医疗补助受益人群中多重用药的患病率为44.6%。在WV南部发现了多重用药的高高聚集区，表明患病率高于平均水平的县被患病率高于平均水平的县所包围。多重用药与年龄较大、女性、因现金援助或医疗资格符合医疗补助条件、患有任何慢性病或更多慢性病以及生活在教育水平较低的县有关。多重用药与更多的住院、急诊就诊和门诊就诊以及更高的非药物医疗支出有关。
多重用药在WV医疗补助受益人群中普遍存在，并与大量的医疗保健利用和支出相关。WV南部多重用药高患病率的聚集可能提示在这些地区采取有针对性的策略来减轻多重用药负担。
