医疗保险覆盖的老年哮喘患者在新冠疫情前后的药物依从性。
Medication adherence in Medicare-enrolled older adults with asthma before and during the coronavirus disease 2019 pandemic.
机构信息
Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio.
Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio; Tabula Rasa HealthCare, Tucson, Arizona.
出版信息
Ann Allergy Asthma Immunol. 2022 May;128(5):561-567.e1. doi: 10.1016/j.anai.2022.02.010. Epub 2022 Feb 25.
BACKGROUND
Data regarding medication adherence in older adults with asthma before and during the coronavirus disease 2019 (COVID-19) pandemic are lacking.
OBJECTIVE
To evaluate medication adherence and determine factors associated with adherence in Medicare-enrolled older adults with asthma before and during the COVID-19 pandemic.
METHODS
This was a retrospective cohort analysis of Medicare-enrolled patients with asthma. Medication adherence was measured using rates of proportion of days covered for dates January to July 2019 and January to July 2020. Patients less than 65 years of age, with chronic obstructive pulmonary disease, or with cystic fibrosis were excluded. Paired t tests assessed change in adherence between 2019 and 2020. Logistic regression evaluated association of age, sex, depression, moderate or severe asthma, use of a 90-day supply, having 3 or more albuterol fills, number of medications, medication-related problems, prescribers, pharmacies, controller medication classes, and systemic corticosteroid fills with high adherence (proportion of days covered ≥ 80%).
RESULTS
Mean adherence to asthma controller medications ranged from 75% to 90%, in 2019. Adherence significantly decreased (P < .001) from 51% to 70% for all controller medications, except theophylline in 2020. Similar results were observed among patients with moderate or severe asthma. In 2019 and 2020, number of controller medications, 3 or more albuterol fills, and having a 90-day supply were associated with high adherence (P < .001).
CONCLUSION
Adherence to asthma controller medications decreased considerably during the COVID-19 pandemic among Medicare-enrolled patients with asthma. Patients with markers for more severe asthma, overuse of albuterol, and a 90-day supply of controller medications were more likely to have high adherence. These findings can be used to identify opportunities to improve adherence and prescribing among adult patients with asthma.
背景
关于新冠疫情期间老年哮喘患者的用药依从性的数据尚缺乏。
目的
评估医疗保险覆盖的老年哮喘患者在新冠疫情前后的用药依从性，并确定与依从性相关的因素。
方法
这是一项针对医疗保险覆盖的哮喘患者的回顾性队列分析。用药依从性通过比例天数覆盖（即 2019 年 1 月至 7 月和 2020 年 1 月至 7 月期间的用药天数占比）来衡量。排除年龄小于 65 岁、患有慢性阻塞性肺疾病或囊性纤维化的患者。配对 t 检验评估了 2019 年和 2020 年之间的依从性变化。Logistic 回归评估了年龄、性别、抑郁、中重度哮喘、使用 90 天供应量、沙丁胺醇使用 3 次以上、药物种类、药物相关问题、处方医生、配药机构、控制药物类别和全身皮质类固醇使用与高依从性（比例天数覆盖≥80%）之间的关联。
结果
2019 年，哮喘控制药物的平均依从率在 75%至 90%之间。2020 年，除茶碱外，所有控制药物的依从率均显著下降（P<0.001），从 51%降至 70%。在中重度哮喘患者中也观察到了类似的结果。2019 年和 2020 年，控制药物种类、沙丁胺醇使用 3 次以上和 90 天供应量与高依从性相关（P<0.001）。
结论
在新冠疫情期间，医疗保险覆盖的哮喘患者的哮喘控制药物依从性显著下降。具有更严重哮喘标志物、过度使用沙丁胺醇和使用 90 天供应量的控制药物的患者更有可能具有高依从性。这些发现可用于确定改善成年哮喘患者依从性和处方的机会。
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