School of Pharmacy, West Virginia University, Morgantown, WV, USA.
System College of Pharmacy, University of North Texas, Fort Worth, TX, USA.
J Asthma. 2022 Mar;59(3):484-493. doi: 10.1080/02770903.2020.1868497. Epub 2021 Jan 19.
Cost-related medication non-adherence (CRN) can negatively impact health outcomes in older adults with asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO) by reducing access and adherence to essential medications. The objective of this study is to examine the association of ACO to any CRN and specific forms of CRN among a nationally representative sample of older (age ≥ 65 years) adults.
We adopted a cross-sectional study design using data from pooled cross-sectional Medicare Current Beneficiary Surveys (MCBS) (2006-2013) and linked fee-for-service Medicare claims. Unadjusted and adjusted logistic regressions that accounted for the complex survey design examined the association of ACO to any CRN and specific forms of CRN.
Among older adults with ACO, 16% reported any CRN. The most common form of CRN was "failing to get prescription". As compared to older adults with no asthma and no COPD, those with ACO were more likely to report any CRN (adjusted odds ratios [AOR] = 1.50, 95%CI = [1.14, 1.96]) and all forms of CRN. However, when the number of unique medications was added to the model, there were no statistically significant differences in CRN between the two groups.
Older adults with ACO represent a vulnerable population with increased risk for CRN. Multiple factors can contribute to CRN including: a higher number of prescribed medications, multiple co-morbidities, and cost of therapies. Medication comprehensive review interventions have the potential of reducing the risk of CRN among the older Medicare beneficiaries with ACO.
与费用相关的药物不依从（CRN）可通过降低获得和坚持使用基本药物的机会来影响患有哮喘和慢性阻塞性肺疾病（COPD）重叠（ACO）的老年患者的健康结果。本研究的目的是在一个具有全国代表性的老年（年龄≥65 岁）成年人样本中，检查 ACO 与任何 CRN 和特定形式的 CRN 之间的关联。
我们采用了横断面研究设计，使用了来自合并的 Medicare 当前受益人大调查（MCBS）（2006-2013 年）和链接的按服务收费 Medicare 索赔的数据。未调整和调整后的逻辑回归考虑了复杂的调查设计，以检查 ACO 与任何 CRN 和特定形式的 CRN 之间的关联。
在患有 ACO 的老年人中，有 16%的人报告有任何 CRN。最常见的 CRN 形式是“未能获得处方”。与没有哮喘和没有 COPD 的老年人相比，患有 ACO 的人更有可能报告有任何 CRN（调整后的优势比 [AOR] = 1.50，95%置信区间 [CI] = [1.14，1.96]）和所有形式的 CRN。然而，当将独特药物的数量添加到模型中时，两组之间的 CRN 没有统计学上的显著差异。
患有 ACO 的老年人是一个弱势群体，CRN 的风险增加。多种因素可能导致 CRN，包括：处方药物数量增加、多种合并症和治疗费用。药物综合审查干预措施有可能降低患有 ACO 的老年 Medicare 受益人的 CRN 风险。
