Alexis A. Krumme (
Robert J. Glynn is a professor of medicine at Harvard Medical School, in Boston, Massachusetts.
Health Aff (Millwood). 2018 Jan;37(1):125-133. doi: 10.1377/hlthaff.2017.0881.
Medication synchronization programs based in pharmacies simplify the refill process by enabling patients to pick up all of their medications on a single visit. This can be especially important for improving medication adherence in patients with complex chronic diseases. We evaluated the impact of two synchronization programs on adherence, cardiovascular events, and resource use among Medicare beneficiaries treated between 2011 and 2014 for two or more chronic conditions-at least one of which was hypertension, hyperlipidemia, or diabetes. Among nearly 23,000 patients matched by propensity score, the mean proportion of days covered (a measure of medication adherence) for the control group of patients without a synchronization program was 0.84 compared to 0.87 for synchronized patients-a gain of 3 percentage points. Adherence improvement in synchronized versus control patients was three times greater in patients with low baseline adherence, compared to those with higher baseline adherence. Rates of hospitalization and emergency department visits and rates of outpatient visits were 9 percent and 3 percent lower in the synchronized group compared to the control group, respectively, while cardiovascular event rates were similar. Synchronization programs were associated with improved adherence for patients with cardiovascular disease, especially those with low baseline adherence.
基于药店的药物同步计划通过使患者在一次就诊时即可领取所有药物，简化了药物补充流程。对于改善患有复杂慢性病的患者的药物依从性，这可能尤为重要。我们评估了两种同步计划对 2011 年至 2014 年期间接受两种或更多种慢性病治疗的医疗保险受益人的依从性、心血管事件和资源使用的影响——至少有一种是高血压、高血脂或糖尿病。在将近 23000 名通过倾向评分匹配的患者中，没有同步计划的对照组患者的平均用药天数（衡量药物依从性的指标）为 0.84，而同步患者为 0.87，提高了 3 个百分点。与基线依从性较高的患者相比，基线依从性较低的患者在同步与对照患者之间的依从性改善幅度要大三倍。与对照组相比，同步组的住院和急诊就诊率分别低 9%和 3%，而门诊就诊率则相似。同步计划与心血管疾病患者的依从性提高有关，尤其是那些基线依从性较低的患者。
