Guo Zhigang, Zheng Liguang, Fu Mengyuan, Li Huangqianyu, Bai Lin, Guan Xiaodong, Shi Luwen
Department of Pharmacy, Peking University School and Hospital of Stomatology, Beijing, China.
International Research Center for Medicinal Administration, Peking University, Beijing, China.
Front Pharmacol. 2022 Feb 3;13:802219. doi: 10.3389/fphar.2022.802219. eCollection 2022.
The full coverage policy for essential medicines (FCPEMs) was proposed and implemented in Taizhou city of Zhejiang Province, China, to promote equal access and adherence to medicines. This study aimed to examine the effects of FCPEMs on the income-related inequality in medication adherence among local patients with hypertension or diabetes. We collected electronic health records of patients with hypertension or diabetes of three districts of Taizhou from 2011 to 2016. As the implementation schedule of the FCPEMs varied across districts, we applied a retrospective longitudinal study design and assigned records from 1 year before to 3 years following the implementation of FCPEMs as baseline and follow-up data. We thus generated a dataset with 4-year longitudinal data. The concentration index (CI) and its decomposition method were employed to measure factors contributing to inequality in medication adherence and the role played by FCPEMs. The sample size rose from 264,836 at the baseline to 315,677, 340,512, and 355,676 by each follow-up year, and the proportion of patients taking free medicines rose from 17.6 to 25.0 and 29.8% after FCPEMs implementation. The proportion of patients with high adherence increased from 39.9% at baseline to 51.6, 57.2, and 60.5%, while CI decreased from 0.073 to -0.011, -0.029, and -0.035. The contribution of FCPEMs ranked at 2/13, 7/13, and 2/13 after the implementation of FCPEMs. Changes in CI of medication adherence for every 2 years were -0.084, -0.018, and -0.006, and the contribution of FCPEMs was -0.006, 0.006, and 0.007, ranking at 2/13, 2/13, and 1/13, respectively. Most changes in CI of medication adherence can be attributed to FCPEMs. The medication adherence of patients with hypertension or diabetes improved after the implementation FCPEMs in Taizhou, although inequality did not improve consistently. In general, FCPEMs could be a protective factor against income-related inequalities in access and adherence to medicines. Future research is needed to investigate the change mechanism and the optimal design of similar interventions.
中国浙江省台州市提出并实施了基本药物全额保障政策（FCPEMs），以促进药物的平等可及性和依从性。本研究旨在探讨FCPEMs对当地高血压或糖尿病患者药物依从性方面与收入相关不平等的影响。我们收集了台州市三个区2011年至2016年高血压或糖尿病患者的电子健康记录。由于FCPEMs的实施时间表在不同区有所不同，我们采用了回顾性纵向研究设计，并将FCPEMs实施前1年至实施后3年的记录作为基线和随访数据。因此，我们生成了一个包含4年纵向数据的数据集。采用集中指数（CI）及其分解方法来衡量导致药物依从性不平等的因素以及FCPEMs所起的作用。样本量从基线时的264,836例增加到每次随访年的315,677例、340,512例和355,676例，实施FCPEMs后服用免费药物的患者比例从17.6%上升到25.0%和29.8%。高依从性患者的比例从基线时的39.9%增加到51.6%、57.2%和60.5%，而CI从0.073降至-0.011、-0.029和-0.035。FCPEMs实施后的贡献率分别为2/13、7/13和2/13。每2年药物依从性CI的变化分别为-0.084、-0.018和-0.006，FCPEMs的贡献率分别为-0.006、0.006和0.007，分别排名2/13、2/13和1/13。药物依从性CI的大多数变化可归因于FCPEMs。台州市实施FCPEMs后，高血压或糖尿病患者的药物依从性有所改善，尽管不平等现象并未持续改善。总体而言，FCPEMs可能是对抗药物获取和依从性方面与收入相关不平等的一个保护因素。未来需要开展研究来调查变化机制以及类似干预措施的最佳设计。
