University of Minnesota College of Pharmacy, Minneapolis.
Center for Medication Optimization, University of North Carolina Eshelman School of Pharmacy, Chapel Hill.
J Manag Care Spec Pharm. 2021 Mar;27(3):399-404. doi: 10.18553/jmcp.2021.27.3.399.
Measures of medication adherence to noninsulin diabetes medications (NIDM), statins, and renin angiotensin system antagonists (RASA) have been continuously used in the star ratings program since 2012. Adherence to these treatments is undoubtedly important. However, the consistent use of these measures in the star ratings program over time has limitations. The purpose of this Viewpoints article is to highlight concerns associated with the current star ratings adherence measures and to offer proposals for the improvement of the adherence measurement in the program. This scoping review outlines concerns with the validity of the 3 star ratings adherence measures. In addition, star ratings data are used to describe payment thresholds for the 3 adherence measures over time to describe concerns associated with their use. Since 2012, there has been significant growth in the proportion of patients considered adherent in the star ratings program. Rates of adherence in a 2-star plan for NIDM (79%), RASA agents (83%), and statins (79%) now exceed what is commonly reported in the clinical literature. For a plan to achieve a rating of 5 stars, more than 88% of patients must be adherent to each measure. These rates suggest a ceiling effect and a reduced ability to distinguish plan performance. In addition, concerns over the potential for plans to "game" these measures have been raised. The use of mail order services, 90-day prescription refill programs, and automatic refill reminders all improve the proportion of days covered measurement but may not reflect true adherence improvements. Given potential concerns associated with the use of the existing adherence measures, it may be time to consider their replacement. One option would be to adopt a broader inventory of chronic medications to measure adherence in the program and to rotate medication categories in the program each year. It might also be time to explore measuring patient adherence to all medications that a patient uses instead of the narrow focus on the 3 existing measures. No funding supported the writing of this article. Farley has nothing to disclose. Urick reports consulting fees from Pharmacy Quality Solutions, unrelated to this work.
自 2012 年以来，衡量非胰岛素类糖尿病药物（NIDM）、他汀类药物和肾素-血管紧张素系统拮抗剂（RASA）药物的用药依从性的措施一直在星级评定计划中持续使用。这些治疗方法的依从性无疑很重要。然而，随着时间的推移，这些措施在星级评定计划中的持续使用存在局限性。本文的观点文章旨在强调与当前星级评定依从性措施相关的问题，并为改善计划中的依从性测量方法提出建议。这项范围综述强调了对 3 项星级评定依从性措施有效性的担忧。此外，星级评定数据用于描述 3 项依从性措施的支付阈值随时间的变化，以描述与使用这些措施相关的问题。自 2012 年以来，在星级评定计划中被认为是依从的患者比例显著增加。NIDM（79%）、RASA 药物（83%）和他汀类药物（79%）的 2 星级计划的依从率现在超过了临床文献中通常报道的水平。为了使一个计划获得 5 星级评级，每个措施的患者依从率必须超过 88%。这些比率表明存在上限效应和区分计划绩效的能力降低。此外，人们对计划“操纵”这些措施的潜在可能性表示担忧。使用邮购服务、90 天处方续药计划和自动续药提醒都可以提高覆盖率测量的比例，但可能无法反映真实的依从性改善。鉴于现有依从性措施使用中存在的潜在问题，可能是时候考虑更换它们了。一种选择是采用更广泛的慢性药物清单来衡量计划中的依从性，并在每年计划中轮换药物类别。也许是时候探索衡量患者对患者使用的所有药物的依从性，而不是将重点狭隘地放在现有的 3 项措施上。本文写作没有得到任何资金支持。Farley 没有要披露的内容。Urick 报告了与这项工作无关的 Pharmacy Quality Solutions 的咨询费。
