Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Gen Intern Med. 2022 Nov;37(14):3645-3652. doi: 10.1007/s11606-021-07334-y. Epub 2022 Jan 11.
The association between nonadherence to chronic medications and potentially preventable healthcare utilization and spending is largely unknown.
To examine the associations of chronic medication nonadherence with potentially preventable utilization and spending among patients who were prescribed diabetic medications, renin-angiotensin system antagonists (RASA) for hypertension, or statins for high cholesterol, and compare the associations by patient race/ethnicity and socioeconomic status.
Retrospective cohort study. Medicare fee-for-service claims data from 2013 to 2016 for 177,881 patients.
Medication nonadherence was defined as having a below 80% proportion of days covered in each 6-month interval after the index prescription. Potentially preventable utilization was measured by preventable emergency department visits and preventable hospitalizations. Potentially preventable spending was calculated as the geographically adjusted spending associated with preventable encounters.
After adjustment for other patient characteristics, medication nonadherence was associated with a 1.7-percentage-point increase (95% confidence interval [CI]: 1.4 to 2.0 percentage points, p < 0.001) in the probability of preventable utilization among the diabetic medication cohort, a 1.7-percentage-point increase (95% CI: 1.5 to 1.9 percentage points, p < 0.001) among the RASA cohort, and a 1.0-percentage-point increase (95% CI: 0.8 to 1.1 percentage points, p < 0.001) among the statin cohort. Among patients with at least one preventable encounter, medication nonadherence was associated with $679-$898 increased preventable spending. The incremental probability of preventable utilization and incremental spending associated with nonadherence were higher among racial/ethnic minority and low socioeconomic groups.
Improving medication adherence is a potential avenue to reducing preventable utilization and spending. Interventions are needed to address racial/ethnic and socioeconomic disparities.
慢性药物治疗不依从与潜在可预防的医疗保健利用和支出之间的关联在很大程度上尚不清楚。
检查糖尿病药物、肾素-血管紧张素系统拮抗剂 (RASA) 治疗高血压或他汀类药物治疗高胆固醇患者的慢性药物治疗不依从与潜在可预防的利用和支出之间的关联，并比较患者种族/族裔和社会经济地位的关联。
回顾性队列研究。使用 2013 年至 2016 年的 177,881 名患者的医疗保险费用服务索赔数据。
药物不依从性定义为在每个 6 个月间隔后的指数处方后，有低于 80%的天数的药物覆盖率。潜在可预防的利用通过可预防的急诊就诊和可预防的住院治疗来衡量。潜在可预防的支出是通过与可预防的遭遇相关的地理调整支出来计算的。
在调整其他患者特征后，药物不依从与糖尿病药物队列中可预防利用的概率增加了 1.7 个百分点（95%置信区间 [CI]：1.4 至 2.0 个百分点，p < 0.001），RASA 队列中增加了 1.7 个百分点（95%置信区间 [CI]：1.5 至 1.9 个百分点，p < 0.001），他汀类药物队列中增加了 1.0 个百分点（95%置信区间 [CI]：0.8 至 1.1 个百分点，p < 0.001）。在至少有一次可预防就诊的患者中，药物不依从与 679 美元至 898 美元的增加的可预防支出相关。与不依从相关的可预防利用和增量支出的增量概率在种族/族裔少数群体和低社会经济群体中更高。
提高药物依从性是减少潜在可预防的利用和支出的潜在途径。需要采取干预措施来解决种族/族裔和社会经济方面的差异。
