医疗保险受益人群的抗高血压和他汀类药物用药依从性。
Antihypertensive and Statin Medication Adherence Among Medicare Beneficiaries.
机构信息
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
出版信息
Am J Prev Med. 2022 Sep;63(3):313-323. doi: 10.1016/j.amepre.2022.02.019. Epub 2022 Jul 21.
INTRODUCTION
Medication adherence is important for optimal management of chronic conditions, including hypertension and hypercholesterolemia. This study describes adherence to antihypertensive and statin medications, individually and collectively, and examines variation in adherence by demographic and geographic characteristics.
METHODS
The 2017 prescription drug event data for beneficiaries with Medicare Part D coverage were assessed. Beneficiaries with a proportion of days covered ≥80% were considered adherent. Adjusted prevalence ratios were estimated to quantify the associations between demographic and geographic characteristics and adherence. Adherence estimates were mapped by county of residence using a spatial empirical Bayesian smoothing technique to enhance stability. Analyses were conducted in 2019‒2021.
RESULTS
Among the 22.5 million beneficiaries prescribed antihypertensive medications, 77.1% were adherent; among the 16.1 million prescribed statin medications, 81.9% were adherent; and among the 13.5 million prescribed antihypertensive and statin medications, 70.3% were adherent to both. Adherence varied by race/ethnicity: American Indian/Alaska Native (adjusted prevalence ratio=0.83, 95% confidence limit=0.82, 0.842), Hispanic (adjusted prevalence ratio=0.90, 95% confidence limit=0.90, 0.91), and non-Hispanic Black (adjusted prevalence ratio=0.87, 95% confidence limit=0.86, 0.87) beneficiaries were less likely to be adherent than non-Hispanic White beneficiaries. County-level adherence ranged across the U.S. from 25.7% to 88.5% for antihypertensive medications, from 36.0% to 93.8% for statin medications, and from 20.8% to 92.9% for both medications combined and tended to be the lowest in the southern U.S.
CONCLUSIONS
This study highlights opportunities for efforts to remove barriers and support medication adherence, especially among racial/ethnic minority groups and within the regions at greatest risk for adverse cardiovascular outcomes.
介绍
药物依从性对于高血压和高胆固醇等慢性疾病的最佳管理非常重要。本研究描述了单独和联合使用抗高血压药物和他汀类药物的依从性，并根据人口统计学和地理特征检查了依从性的变化。
方法
评估了 2017 年有医疗保险 D 部分覆盖的受益人的处方药事件数据。将比例天数覆盖率≥80%的受益者视为依从者。估计了调整后的流行率比值，以量化人口统计学和地理特征与依从性之间的关联。使用空间经验贝叶斯平滑技术对居住县的依从性估计值进行映射，以增强稳定性。分析于 2019-2021 年进行。
结果
在被开处抗高血压药物的 2250 万受益人中，有 77.1%的人依从；在被开处他汀类药物的 1610 万受益人中，有 81.9%的人依从；在被开处抗高血压和他汀类药物的 1350 万受益人中，有 70.3%的人同时服用两种药物。依从性因种族/族裔而异：美洲印第安人/阿拉斯加原住民（调整后的流行率比值=0.83，95%置信区间=0.82，0.842）、西班牙裔（调整后的流行率比值=0.90，95%置信区间=0.90，0.91）和非西班牙裔黑人（调整后的流行率比值=0.87，95%置信区间=0.86，0.87）的受益人的依从性低于非西班牙裔白人受益人的依从性。全美范围内，抗高血压药物的县一级依从率从 25.7%到 88.5%不等，他汀类药物的县一级依从率从 36.0%到 93.8%不等，同时服用两种药物的县一级依从率从 20.8%到 92.9%不等，南部地区的依从率往往最低。
结论
本研究强调了努力消除障碍和支持药物依从性的机会，特别是在少数族裔群体中和在心血管不良后果风险最高的地区。
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