Learnihan Vincent, Schroers Ralf-D, Coote Philip, Blake Marcus, Coffee Neil T, Daniel Mark
Health Research Institute, University of Canberra, Australia.
Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia.
SSM Popul Health. 2021 Dec 24;17:101013. doi: 10.1016/j.ssmph.2021.101013. eCollection 2022 Mar.
Much is known about the adverse impacts on diabetes outcomes of non-adherence to diabetes medication. Less is known about how adherence to diabetes medication varies geographically, and the correspondence of this variation to social and contextual factors. Using pharmacy claims data over a two-year period, this study analysed non-adherence to biguanide medication for N=24,387 adult Medicaid enrolees diagnosed with Type 2 Diabetes Mellitus (T2DM) and residing in Ohio. Spatial analysis was used to detect clusters of census tract level rates of non-adherence, defined as the proportion of patients below the Proportion Days Covered (PDC) threshold of 80%, the level at which patients have a reasonable likelihood of achieving most clinical benefit from their medication. Multilevel models were used to understand associations between medication non-adherence and contextual factors including social vulnerability, urbanicity and distance to utilised pharmacy, with adjustment for individual-level covariates. These findings indicate that contextual factors are associated with medication non-adherence in Medicaid clients with T2DM. They suggest a need for spatially specific, multifaceted intervention programmes that target and/or account for the features of residential settings beyond individual and health system-level factors alone. While "environmental" considerations are often acknowledged, few intervention initiatives are predicated on explicit knowledge of spatially variable influences that can be targeted to enable and support medication adherence.
关于不坚持服用糖尿病药物对糖尿病治疗结果的不利影响，我们已经了解很多。但对于糖尿病药物的依从性在地理上的差异，以及这种差异与社会和环境因素的对应关系，我们了解得较少。本研究利用两年期间的药房报销数据，分析了N = 24387名被诊断为2型糖尿病（T2DM）且居住在俄亥俄州的成年医疗补助参保者对双胍类药物的不依从情况。空间分析用于检测人口普查区层面不依从率的聚集情况，不依从定义为低于80%的覆盖天数比例（PDC）阈值的患者比例，在这个水平上患者有合理的可能性从其药物治疗中获得最大临床益处。多水平模型用于了解药物不依从与包括社会脆弱性、城市化程度和到所使用药房的距离等环境因素之间的关联，并对个体层面的协变量进行了调整。这些发现表明，环境因素与患有T2DM的医疗补助客户的药物不依从有关。它们表明需要针对居住环境特征制定空间特定的多方面干预计划，这些计划不仅要考虑个体和卫生系统层面的因素，还要考虑居住环境的特征。虽然人们经常承认“环境”因素的重要性，但很少有干预措施是基于对可针对性地促进和支持药物依从性的空间可变影响的明确认识而制定的。
