Zhang Weiwei, Lv Gang, Xiong Xiaomo, Li Minghui
Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Front Med (Lausanne). 2021 Jun 17;8:670034. doi: 10.3389/fmed.2021.670034. eCollection 2021.
Medication therapy management (MTM) was established by the Center for Medicare and Medicaid Services (CMS) with the aim to improve medication adherence. However, the national prevalence of cost-related medication non-adherence (CRN) is still unknown and there is a literature gap in the association between MTM services and CRN. A cross-sectional study was conducted. A nationally representative study sample from Medicare Current Beneficiary Surveys (MCBS) was used. Survey sampling weights were applied for national estimates of CRN. Weighted multivariable logistic regressions controlling for covariates were conducted to investigate the effect of the MTM on the CRN. The study identified 1,549 MTM-eligible beneficiaries. The prevalence of CRN was higher in MTM-eligible individuals than in non-MTM eligible individuals (24.14 vs. 13.44%; < 0.001). According to the results of multivariable logistic regressions, we found that MTM eligibility was significantly associated with a higher prevalence of CRN (OR: 1.59; 95% CI: 1.28-1.96). Additionally, some other variables such as health status, with or without low-income subsidy are also associated with CRN. Our findings suggest that the prevalence of CRN in MTM-eligible beneficiaries was higher than in non-MTM eligible beneficiaries. Further studies with the longitudinal design are warranted to clarify the relationship between MTM and CRN. Alternative strategies to improve CRN should be considered in future Medicare Part D Enhanced MTM Models.
药物治疗管理（MTM）由医疗保险和医疗补助服务中心（CMS）设立，旨在提高药物依从性。然而，与费用相关的药物不依从（CRN）的全国患病率仍然未知，并且在MTM服务与CRN之间的关联方面存在文献空白。开展了一项横断面研究。使用了来自医疗保险当前受益人调查（MCBS）的具有全国代表性的研究样本。调查抽样权重用于CRN的全国估计。进行了控制协变量的加权多变量逻辑回归，以研究MTM对CRN的影响。该研究确定了1549名符合MTM条件的受益人。符合MTM条件的个体中CRN的患病率高于不符合MTM条件的个体（24.14%对13.44%；<0.001）。根据多变量逻辑回归结果，我们发现符合MTM条件与CRN的较高患病率显著相关（OR：1.59；95%CI：1.28 - 1.96）。此外，一些其他变量，如健康状况、有无低收入补贴等也与CRN相关。我们的研究结果表明，符合MTM条件的受益人中CRN的患病率高于不符合MTM条件的受益人。有必要进行进一步的纵向设计研究，以阐明MTM与CRN之间的关系。在未来的医疗保险D部分强化MTM模型中应考虑改善CRN的替代策略。
