Yao Shenzhen, Lix Lisa, Shevchuk Yvonne, Teare Gary, Blackburn David F
University of Saskatchewan.
University of Manitoba.
J Popul Ther Clin Pharmacol. 2018 Jan 15;25(1):e1-e17. doi: 10.22374/1710-6222.25.1.1.
In 2007, a drug benefit plan for Seniors (SDP) was launched in Saskatchewan, Canada. SDP capped out-of-pocket costs at $15 per prescription for individuals aged 65 and older.
To quantify the impact of the SDP on chronic medication adherence. Methods: A retrospective cohort study was conducted for participants aged 65 or older who were eligible to the SPD, controlled by a younger group aged 40 to 64 who were ineligible. Adherence was measured over 365 days using medication possession ratio (MPR). MPRs were compared between age groups, and between pre and post SDP-launch periods. The odds ratio of optimal adherence (i.e., MPR≥80%) was estimated using logistic regression models with generalized estimating equations (GEE).
Between 2005 and 2009, 353,568 adherence observations were observed from 188,109 unique patients. Comparing the post-SDP period vs before, the increase in the odds of optimal medication adherence was significant (OR=1.08, 95% CI: 1.04 to 1.11) and was stronger after excluding patients already receiving medication benefits from other government programs (OR= 1.21, 95% CI: 1.16 to 1.26). The SDP was associated with improved adherence among the subgroup of prevalent medication users (OR=1.08, 95% CI: 1.04 to 1.12), but not incident users (OR=1.05, 95% CI: 0.98 to 1.13).
Reducing out-of-pocket medication costs for seniors was associated with small improvements in medication adherence across the population.
2007年，加拿大萨斯喀彻温省推出了一项老年人药物福利计划（SDP）。SDP为65岁及以上的个人设定了每次处方自付费用上限为15加元。
量化SDP对慢性药物依从性的影响。方法：对符合SDP资格的65岁及以上参与者进行回顾性队列研究，由不符合资格的40至64岁较年轻组进行对照。使用药物持有率（MPR）在365天内测量依从性。比较年龄组之间以及SDP推出前后的MPR。使用带有广义估计方程（GEE）的逻辑回归模型估计最佳依从性（即MPR≥80%）的优势比。
2005年至2009年期间，从188,109名独特患者中观察到353,568次依从性观察。将SDP实施后时期与之前进行比较，最佳药物依从性的优势比增加显著（OR = 1.08，95% CI：1.04至1.11），在排除已从其他政府计划获得药物福利的患者后更强（OR = 1.21，95% CI：1.16至1.26）。SDP与现有药物使用者亚组中依从性的改善相关（OR = 1.08，95% CI：1.04至1.12），但与新使用者无关（OR = 1.05，95% CI：0.98至1.13）。
降低老年人的自付药物费用与总体人群药物依从性的小幅改善相关。
