Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA.
Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA.
Curr Med Res Opin. 2021 Sep;37(9):1581-1588. doi: 10.1080/03007995.2021.1935224. Epub 2021 Jun 24.
Older patients with Alzheimer's disease (AD) are challenged with adhering to complex medication regimens. We examined effects of Comprehensive Medication Review (CMR), a required Medicare Part D Medication Therapy Management (MTM) program component, on medication adherence among AD patients.
This retrospective study analyzed 100% of 2016-2017 Medicare claims covering the entire United States, linked to Area Health Resources Files. Medicare beneficiaries aged ≥65 years were included. Propensity score matching identified comparable intervention and comparison groups with the intervention defined as receiving a CMR in 2017. A difference-in-differences analysis included in multivariate logistic regressions an interaction term between CMR receipt and year 2017. The outcome measured was nonadherence to diabetes, hypertension and hyperlipidemia medications, with nonadherence defined as proportion of days covered <80% for study medications.
Unadjusted comparisons indicated the proportion of nonadherence for intervention group members decreased from 2016 to 2017 but increased for the comparison group. In adjusted analyses, reduction in medication nonadherence among the intervention group remained higher: odds ratios for the interaction term were 0.62 (95% confidence interval [CI] = 0.54-0.71), 0.54 (95% CI = 0.50-0.58) and 0.50 (95% CI = 0.47-0.53) respectively for diabetes, hypertension and hyperlipidemia medications. This suggests that the likelihood of nonadherence in the intervention group was respectively reduced by 38%, 46% and 50% more than the comparison group.
CMR was found to reduce nonadherence to diabetes, hypertension and hyperlipidemia medications among older Medicare beneficiaries with AD. This provides evidence that the MTM program is effective for a population with unique medication compliance challenges.
患有老年痴呆症（AD）的老年患者在遵守复杂的药物治疗方案方面面临挑战。我们研究了综合药物审查（CMR）的效果，CMR 是医疗保险计划 D 部分药物治疗管理（MTM）的要求，对 AD 患者的药物依从性的影响。
这项回顾性研究分析了 2016-2017 年涵盖整个美国的 100%医疗保险索赔，与区域卫生资源文件相关联。纳入年龄≥65 岁的医疗保险受益人。倾向评分匹配确定了可比较的干预组和对照组，干预定义为在 2017 年接受 CMR。多元逻辑回归中的差异-差异分析包括 CMR 接受和 2017 年的交互项。测量的结果是糖尿病、高血压和高血脂药物的不依从性，不依从性定义为研究药物的覆盖天数比例<80%。
未经调整的比较表明，干预组的不依从比例从 2016 年到 2017 年下降，但对照组的不依从比例上升。在调整分析中，干预组的药物不依从率降低仍然较高：交互项的比值比分别为 0.62（95%置信区间[CI] = 0.54-0.71）、0.54（95% CI = 0.50-0.58）和 0.50（95% CI = 0.47-0.53），分别用于糖尿病、高血压和高血脂药物。这表明，干预组的不依从可能性比对照组分别降低了 38%、46%和 50%。
CMR 被发现可以降低患有 AD 的老年医疗保险受益人的糖尿病、高血压和高血脂药物的不依从性。这为 MTM 计划对具有独特药物依从性挑战的人群有效提供了证据。
