Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
J Gerontol A Biol Sci Med Sci. 2023 Mar 1;78(3):463-469. doi: 10.1093/gerona/glac096.
Polypharmacy is highly prevalent among older adults. This study's purpose was to provide nationally representative estimates of self-reported comprehensive medication review (CMR) receipt among older adults and describe factors associated with their receipt, as CMRs are available through the Medicare Part D program.
This cross-sectional study used data from the National Poll on Healthy Aging (NPHA), a nationally representative online survey of community-dwelling adults aged 50-80, administered in December 2019. Participants included older adults aged 65-80 with any health insurance (n = 960). Outcomes were self-reported CMR receipt, awareness of CMR insurance coverage, and interest in a future CMR with a pharmacist. Sociodemographic and health-related variables were included. Descriptive statistics and multivariable logistic regression with NPHA population sampling weights were used.
Among older adults on 2 or more prescription medications, only 20.8% had received a CMR while 34.3% were interested in a future CMR. Among individuals who had not received a CMR, most (83.4%) were unaware their insurance might cover a CMR. Factors associated with higher odds of receiving a CMR included taking 5 or more prescription medications (adjusted odds ratio [AOR] = 2.6, 95% CI: 1.59-4.38) and reporting food insecurity (AOR = 2.9, 95% CI: 1.07-7.93). Having fair or poor self-reported physical health was associated with lower odds of receiving a CMR (AOR = 0.49, 95% CI: 0.25-0.97).
Most older adults on 2 or more prescription medications with health insurance had not received a CMR and many were interested in one. Targeted strategies to increase older adults' awareness and receipt of CMRs are warranted.
老年人普遍存在多重用药的情况。本研究旨在提供全国范围内报告的老年人综合药物评估（CMR）接受情况的代表性估计，并描述与接受 CMR 相关的因素，因为 CMR 可通过医疗保险计划获得。
这项横断面研究使用了全国健康老龄化民意调查（NPHA）的数据，这是一项针对年龄在 50-80 岁之间、居住在社区的成年人的全国性在线调查。参与者包括年龄在 65-80 岁之间、有任何医疗保险的成年人（n=960）。结果是自我报告的 CMR 接受情况、对 CMR 保险覆盖范围的认知以及对未来与药剂师进行 CMR 的兴趣。纳入了社会人口统计学和与健康相关的变量。使用 NPHA 人群抽样权重进行描述性统计和多变量逻辑回归。
在服用两种或两种以上处方药的老年人中，只有 20.8%的人接受过 CMR，而 34.3%的人对未来的 CMR 感兴趣。在没有接受 CMR 的人群中，大多数（83.4%）不知道他们的保险可能涵盖 CMR。与接受 CMR 的可能性更高相关的因素包括服用 5 种或 5 种以上处方药（调整后的优势比 [AOR] = 2.6，95%置信区间：1.59-4.38）和报告食物不安全（AOR = 2.9，95%置信区间：1.07-7.93）。自我报告的身体健康状况一般或较差与接受 CMR 的可能性较低相关（AOR = 0.49，95%置信区间：0.25-0.97）。
大多数有保险、服用两种或两种以上处方药的老年人尚未接受 CMR，许多人对此感兴趣。有必要采取有针对性的策略来提高老年人对 CMR 的认知和接受程度。
