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少即是多:减少健康监测能否提高药物依从性?

When less is more: Can reduced health monitoring improve medication adherence?

机构信息

CIDE, Carretera México-Toluca 3655, Lomas de Santa Fe, DF 01210, Mexico.

出版信息

J Health Econ. 2021 Jan;75:102387. doi: 10.1016/j.jhealeco.2020.102387. Epub 2020 Oct 31.

Abstract

As the prevalence of chronic diseases rises, improving self-management has become an important determinant of the productivity of healthcare delivery. Recently, Mexico's largest healthcare provider began issuing automatic-refill prescriptions to stable hypertensive patients, thus reducing the frequency of health monitoring from 30- to 90-day intervals. Exploiting this change, I find that less monitoring implies no drawbacks in health outcomes and actually improves self-management of disease by increasing medication adherence when baseline monitoring is relatively frequent. The number of days when patients are out of medication between fillings falls by 2.2 days-an improvement in adherence of 6.4%. Furthermore, patients appear to value being on a low-frequency regime as they improve adherence in order to remain on it, suggesting that lower monitoring could be used as a "reward" to promote medication adherence or, potentially, other health behaviors. Finally, I find evidence of positive spillovers on adherence, as clinic congestion falls.

摘要

随着慢性病患病率的上升,改善自我管理已成为医疗服务效率的重要决定因素。最近,墨西哥最大的医疗服务提供商开始向稳定的高血压患者发放自动续方,从而将健康监测的频率从 30 天延长至 90 天。利用这一变化,我发现,当基线监测较为频繁时,监测频率的降低不会对健康结果造成不利影响,反而会通过提高药物依从性来改善疾病的自我管理,当基线监测较为频繁时,药物依从性提高了 6.4%。此外,由于每次配药之间的停药天数减少了 2.2 天,患者似乎非常重视低频率治疗方案,为了保持这种方案,他们会提高药物依从性,这表明,降低监测频率可以作为一种“奖励”,以促进药物依从性或可能促进其他健康行为。最后,我发现,由于就诊拥挤程度下降,依从性方面出现了积极的溢出效应。

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