Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA.
Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN, 38163, USA.
BMC Health Serv Res. 2022 Feb 7;22(1):159. doi: 10.1186/s12913-022-07483-8.
Alzheimer's Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population.
This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference).
The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks' nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics' nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant.
Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.
阿尔茨海默病（AD）是痴呆症最常见的病因，痴呆症是一种以记忆丧失和判断力受损为特征的神经退行性疾病。血脂异常是一种常见的合并症，应加以治疗以预防相关并发症。由于 AD 管理的复杂性，AD 患者可能难以坚持用药。综合药物审查（CMR）是医疗保险 D 部分药物治疗管理（MTM）的必要组成部分，已被证明可以提高药物依从性。然而，许多 MTM 计划并未针对 AD。此外，在 MTM 资格方面存在种族/民族差异。因此，本研究探讨了 CMR 接受情况对降低 AD 患者中血脂异常药物（他汀类药物）不依从种族/民族差异的影响。
本回顾性研究使用了 2015-2017 年医疗保险数据，并与区域卫生资源文件相关联。在倾向评分匹配的 CMR 接受者和未接受者中，比较了不同种族/民族组他汀类药物不依从的可能性，比例为 1:3。使用逻辑回归通过包括 CMR 接受者和每个少数族裔群体（非西班牙裔白人或白人，作为参考）的虚拟变量之间的交互项，采用差异中的差异方法确定种族/民族差异模式。
该研究纳入了 623400 名医疗保险受益人。黑人及西班牙裔人群的他汀类药物不依从率高于白人：与白人相比，CMR 接受者中黑人的不依从率高 4.53%，而非接受者中高 7.35%；CMR 接受者中西班牙裔的不依从率高 2.69%，而非接受者中高 7.38%。除了其他群体之外，CMR 接受者和未接受者之间的每个少数群体的种族/民族差异均有显著差异（p<0.05）。与非接受者相比，CMR 接受者中白人和西班牙裔人群他汀类药物不依从的几率降低了 11%（OR=0.89；95%置信区间为 0.85-0.94，CMR 和西班牙裔之间的交互项）。CMR 和其他种族/民族少数群体的虚拟变量之间的交互项不显著。
在 AD 患者中，接受 CMR 与降低西班牙裔和白人之间他汀类药物不依从的差异有关。需要探索增加针对 AD 的 MTM 计划数量并促进 CMR 完成的策略。
