Dong Xiaobei, Tsang Chi Chun Steve, Wan Jim Y, Shih Yachen Tina, Chisholm-Burns Marie A, Dagogo-Jack Samuel, Cushman William C, Hines Lisa E, Wang Junling
Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 214, Memphis, TN 38163.
Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 212, Memphis, TN 38163.
Explor Res Clin Soc Pharm. 2021 Sep;3. doi: 10.1016/j.rcsop.2021.100041. Epub 2021 Jun 25.
There has been a lack of evidence on whether there are racial and ethnic disparities in medication nonadherence among individuals receiving comprehensive medication review (CMR), a required component of the Medicare Part D medication therapy management (MTM) services.
To explore racial/ethnic disparities in medication nonadherence among older MTM enrollees who received a CMR and to determine how much the identified disparities can be explained by observed characteristics.
The retrospective study used 100% of the 2017 Medicare claims, including MTM data. Linked Area Health Resources Files provided community characteristics. Nonadherence was defined as proportion of days covered <80%, and was measured for diabetes, hypertension, and hyperlipidemia medications. Racial/ethnic disparities were examined by logistic regressions that included racial/ethnic minority dummy variables. A nonlinear Blinder-Oaxaca decomposition method was applied to decompose the identified disparities.
Compared with non-Hispanic Whites (Whites), Blacks were respectively 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.33-1.45), 27% (OR = 1.27, 95% CI = 1.22-1.32), and 43% (OR = 1.43, 95% CI = 1.39-1.47) more likely to be nonadherent to diabetes, hypertension, and hyperlipidemia medications; Hispanics were 20% (OR = 1.20, 95% CI = 1.14-1.27) more likely to be nonadherent to hyperlipidemia medications. The total portion of disparity explained was 13.42%, 7.66%, 14.87%, and 10.69% respectively for disparities in Black-White (B-W) diabetes, B-W hypertension, B-W hyperlipidemia, and Hispanic-White hyperlipidemia. The top three contributors were the proportion of married-couple families, census region, and male gender.
A lower level of community affluence and social support, regional variations, and a lower proportion of males in Blacks and Hispanics may contribute to the disparities in medication nonadherence. The large unexplained portion of the disparity attests that nonadherence is a complex issue. The Medicare MTM program needs to implement measures to reduce disparities in medication adherence.
对于接受全面药物审查（CMR）的个体而言，在药物治疗不依从方面是否存在种族和民族差异，目前缺乏证据。全面药物审查是医疗保险D部分药物治疗管理（MTM）服务的一个必要组成部分。
探讨接受CMR的老年MTM参保者在药物治疗不依从方面的种族/民族差异，并确定所识别出的差异中有多少可由观察到的特征来解释。
这项回顾性研究使用了2017年医疗保险索赔的100%数据，包括MTM数据。关联的地区卫生资源文件提供了社区特征。不依从被定义为覆盖天数的比例<80%，并针对糖尿病、高血压和高脂血症药物进行测量。通过包含种族/民族少数群体虚拟变量的逻辑回归来检验种族/民族差异。应用非线性布林德-奥瓦卡分解方法来分解所识别出的差异。
与非西班牙裔白人（白人）相比，黑人不依从糖尿病、高血压和高脂血症药物的可能性分别高出39%（优势比[OR]=1.39，95%置信区间[CI]=1.33-1.45）、27%（OR=1.27，95%CI=1.22-1.32）和43%（OR=1.43，95%CI=1.39-1.47）；西班牙裔不依从高脂血症药物的可能性高出20%（OR=1.20，95%CI=1.14-1.27）。在黑人与白人（B-W）糖尿病、B-W高血压、B-W高脂血症以及西班牙裔与白人高脂血症的差异中，所解释的差异总比例分别为13.42%、7.66%、14.87%和10.69%。前三大影响因素分别是夫妻家庭比例、人口普查地区和男性性别。
社区富裕程度和社会支持水平较低、地区差异以及黑人和西班牙裔中男性比例较低可能导致药物治疗不依从方面的差异。差异中未得到解释的很大一部分证明不依从是一个复杂的问题。医疗保险MTM计划需要采取措施来减少药物依从性方面的差异。
