Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, 911 Broxton Avenue, Los Angeles, CA, 90024, USA.
Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
J Racial Ethn Health Disparities. 2018 Dec;5(6):1373-1380. doi: 10.1007/s40615-018-0487-9. Epub 2018 Mar 29.
Use of an Internet portal to refill medicines positively affects medication adherence among English-speakers. No prior studies, however, have specifically examined the relationship between Internet refills and medication adherence among patients who are limited English proficient (LEP).
(1) Examine the relationship between Internet medication refill system use and medication adherence among linguistically diverse patients with chronic conditions and (2) compare this relationship between LEP and English-proficient (EP) patients.
DESIGN, PARTICIPANTS, MEASURES: We analyzed 2013-2014 cross-sectional data from 509 surveyed adults in the Group Health Cooperative. Surveys were merged with plan enrollment, claims data, and electronic medical records. Medication adherence was calculated by the "Continuous Measure of Medication Gaps" (CMG) method. For Internet refill system use, patients were asked, "Have you used the health systems Internet site to refill any medications in the last 12 months?" LEP status was captured in the electronic medical record by a non-English primary language and a claims record of interpreter use in at least one clinical encounter between 2005 and 2012. We used multivariate linear regression models to examine Internet refill system use and medication adherence and compared the association between LEP and EP patients.
Three hundred eighty-four patients (75%) had a calculable CMG: 134 EP and 250 LEP in the adherence analyses. In unadjusted analyses, LEP patients had lower use of the Internet refill system (p < .001) and lower adherence versus the EP group (p < .001). In multivariate analyses, LEP status (β = - 0.022, p = .047) was negatively associated with adherence, while use of the Internet refill system (β = 0.030, p = .002) was positively associated. In stratified models, use of Internet refills was positively associated with adherence, even when examining LEP (β = 0.029, p = .003) and EP patients (β = 0.027, p = .049) separately.
These findings suggest that LEP patients may be under-utilizing a beneficial Internet tool. Should our healthcare systems fail to ensure that LEP patients have full and meaningful access to Internet patient portals, we risk worsening healthcare disparities.
使用互联网门户来续药会对讲英语者的用药依从性产生积极影响。然而，此前尚无研究专门探讨互联网续药与语言能力有限的患者（LEP）的药物治疗依从性之间的关系。
（1）考察在患有慢性疾病的语言多样化患者中，互联网药物续药系统的使用与药物治疗依从性之间的关系；（2）比较 LEP 患者与英语熟练（EP）患者之间的这种关系。
设计、参与者、措施：我们分析了 2013 年至 2014 年间，509 名接受调查的群体健康合作组织成年患者的横断面数据。调查结果与计划登记、理赔数据和电子病历进行了合并。通过“连续测量药物间隙”（CMG）方法计算药物依从性。对于互联网续药系统的使用，患者被问到，“在过去 12 个月中，您是否使用健康系统的互联网网站来续药？”在电子病历中，通过非英语的主要语言和 2005 年至 2012 年期间至少有一次临床就诊中使用口译员的理赔记录来捕获 LEP 状态。我们使用多元线性回归模型来检验互联网续药系统的使用与药物治疗依从性，并比较 LEP 与 EP 患者之间的关联。
384 名患者（75%）可计算出 CMG：134 名 EP 和 250 名 LEP 用于依从性分析。在未调整的分析中，LEP 患者的互联网续药系统使用率较低（p < 0.001），且与 EP 组相比，其依从性较低（p < 0.001）。在多变量分析中，LEP 状态（β = -0.022，p = 0.047）与依从性呈负相关，而互联网续药系统的使用（β = 0.030，p = 0.002）与依从性呈正相关。在分层模型中，即使分别检查 LEP（β = 0.029，p = 0.003）和 EP 患者（β = 0.027，p = 0.049），互联网续药的使用也与依从性呈正相关。
这些发现表明，LEP 患者可能没有充分利用这一有益的互联网工具。如果我们的医疗保健系统未能确保 LEP 患者充分、有意义地访问互联网患者门户，我们可能会加剧医疗保健差异。
