Gelzer Andrea D, Gao Wanzhen, Keleti David, Donia Thomas, Megargell Lauren, Kreitman Jeffrey, Michael Karen E
a Medical Executive Management, AmeriHealth Caritas , Philadelphia , PA , USA.
b Corporate Informatics, AmeriHealth Caritas , Philadelphia , PA , USA.
J Asthma. 2019 Feb;56(2):190-199. doi: 10.1080/02770903.2018.1439954. Epub 2018 Mar 22.
To measure the effectiveness of managed care-led interventions in Medicaid subjects with asthma on medication adherence and acute hospitalization in Pennsylvania.
A total of 3589 members (age range, 5-64 years) served by two Pennsylvania-based Medicaid managed care plans (southeastern Pennsylvania [SEPA] and Lehigh-Capital/New West Pennsylvania [LCNWPA]) with low adherence rates (proportion of days covered [PDC]; 20%-67%) for asthma controller prescription fills in 2012 were guided through a care continuum by a comprehensive asthma strategy, consisting of adherence-improvement interventions (grouped as general intervention [GI] or personalized intervention [PI] for higher-risk subjects). Medication adherence and acute hospitalization rates (emergency department [ED] and inpatient [IP]) were compared at baseline versus one-year post-intervention using paired t-test or signed-rank tests. Repeated measures analysis of variances detected the interaction effect of time by intervention group after controlling for sociodemographic covariates.
Member profiles in SEPA (n = 2 796) and LCNWPA (n = 793) were racially and ethnically distinct. Both cohorts experienced statistically significant improvements in mean PDC rate (+4.9% and +7.2%; p = 0.01 and p = 0.03, respectively), accompanied by significant reductions in ED visits (asthma-related: -23.0% and -17.5%, respectively; p < 0.01), and IP admissions (asthma-related: -37.1% and -40.0%, respectively; p < 0.01). The PI subcohorts showed significantly greater improvements in mean PDC versus GI subcohorts (p ≤ 0.04), whereas acute hospitalization rates were statistically comparable in the SEPA cohort, despite its greater asthma burden.
Managed care-led interventions can effectively improve medication adherence and reduce acute hospitalizations in high-risk Medicaid populations.
评估宾夕法尼亚州医疗补助计划中，由管理式医疗主导的干预措施对哮喘患者药物依从性及急性住院率的影响。
2012年，宾夕法尼亚州两家医疗补助管理式医疗计划（宾夕法尼亚州东南部[SEPA]和利哈伊-首都/新西宾夕法尼亚[LCNWPA]）所服务的共3589名成员（年龄范围5 - 64岁），哮喘控制药物处方的依从率较低（覆盖天数比例[PDC]；20% - 67%），通过一项综合哮喘策略接受全程护理指导，该策略包括提高依从性的干预措施（分为针对高风险受试者的一般干预[GI]或个性化干预[PI]）。使用配对t检验或符号秩检验比较干预前基线与干预一年后的药物依从性和急性住院率（急诊科[ED]和住院部[IP]）。在控制社会人口统计学协变量后，重复测量方差分析检测干预组随时间的交互作用。
SEPA（n = 2796）和LCNWPA（n = 793）的成员特征在种族和民族上存在差异。两个队列的平均PDC率均有统计学显著改善（分别提高4.9%和7.2%；p = 0.01和p = 0.03），同时ED就诊次数显著减少（与哮喘相关的分别减少23.0%和17.5%；p < 0.01），IP入院次数也显著减少（与哮喘相关的分别减少37.1%和40.0%；p < 0.01）。PI亚组的平均PDC改善程度显著大于GI亚组（p ≤ 0.04），而在SEPA队列中，尽管哮喘负担更重，但其急性住院率在统计学上与其他组相当。
由管理式医疗主导的干预措施可有效提高高风险医疗补助人群的药物依从性并降低急性住院率。
