老年人中药物使用及其对高成本医疗保健使用者的影响：基于人群匹配队列 HiCOSTT 研究的方案。

Medication use and its impact on high-cost health care users among older adults: protocol for the population-based matched cohort HiCOSTT study.

机构信息

Division of Geriatric Medicine (Lee), Department of Medicine, and Department of Health Research Methods, Evidence, and Impact (Lee, Muratov, Tarride, Mbuagbaw, Seow, Thabane, Holbrook), and Centre for Health Economics and Policy Analysis (CHEPA) (Tarride), McMaster University, Hamilton, Ont.; ICES (Paterson, Gomes, Khuu, Seow, Thavorn); Institute of Health Policy, Management and Evaluation (Paterson, Thavorn), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Thavorn), The Ottawa Hospital, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital, Toronto, Ont.; Department of Oncology (Seow), Faculty of Health Sciences, and Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.

出版信息

CMAJ Open. 2021 Jan 11;9(1):E44-E52. doi: 10.9778/cmajo.20190196. Print 2021 Jan-Mar.

DOI:10.9778/cmajo.20190196

PMID:33436455

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7843076/

Abstract

BACKGROUND

Health interventions and policies for high-cost health care users (HCUs) who are older adults need to be informed by a better understanding of their multimorbidity and medication use. This study aims to determine the financial contribution of medications to HCU expenditures and explore whether potentially inappropriate prescribing is associated with incident HCU development.

METHODS

This is a protocol for a retrospective population-based matched cohort analysis of incident older adult HCUs (those with the highest 5% of costs and 66 years of age or older) in Ontario during fiscal year 2013. We will obtain person-level data for the index year and year before HCU status from health administrative databases and match each HCU to 3 non-HCUs based on age, sex and geographic location. Average annual medication costs (per patient) and the ratio of medication to total health care costs (at population level) will be examined over the HCU transition period and compared with non-HCUs. We will explore potential quality improvement areas for prescribing by analyzing chronic conditions and the use of medications with a strong evidence base for either clinical benefit or risk of harms outweighing benefits in older adults with these diagnoses. The relation between these medication classes and incident HCU status will be explored using logistic regression.

INTERPRETATION

Using a matched cohort design and focusing on incident rather than prevalent HCUs, this protocol will explore our hypotheses that medications and the quality of their prescribing may be important triggers of HCU status and facilitate the identification of potential preventive clinical interventions or policies. Dissemination of results will occur via publications in peer-reviewed journals, presentations at conferences and academic settings, and knowledge translation activities with relevant health system and patient stakeholder groups.

STUDY REGISTRATION

Clinicaltrials.gov, no. NCT02815930.

摘要

背景

需要更好地了解老年高成本医疗保健使用者（HCU）的多病共存和用药情况，为针对他们的卫生干预措施和政策提供信息。本研究旨在确定药物对 HCU 支出的财务贡献，并探讨潜在不适当处方与 HCU 发病之间的关系。

方法

这是一项基于人群的回顾性匹配队列分析研究方案，研究对象为安大略省在 2013 财政年度新出现的老年 HCU（费用最高的 5%和 66 岁或以上的人群）。我们将从健康管理数据库中获取索引年度和 HCU 状态发生前一年的个人水平数据，并根据年龄、性别和地理位置将每个 HCU 与 3 个非 HCU 进行匹配。在 HCU 过渡期间，将检查每个患者的平均年药物费用（按患者计算）以及药物与总医疗保健费用的比例（按人群计算），并与非 HCU 进行比较。我们将通过分析慢性疾病以及在这些诊断中老年患者具有临床获益或风险大于获益的药物使用情况，来探索处方方面的潜在质量改进领域。使用逻辑回归探讨这些药物类别与 HCU 发病之间的关系。

解释

使用匹配队列设计，重点关注新出现的而非现患的 HCU，本方案将探讨我们的假设，即药物及其开具质量可能是 HCU 状态的重要触发因素，并有助于确定潜在的预防性临床干预或政策。将通过在同行评议期刊上发表文章、在会议和学术环境中进行演示以及与相关卫生系统和患者利益相关者群体开展知识转化活动来传播研究结果。