Department of Pharmacotherapy, College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Blvd, Fort Worth, TX 76107. Email:
Am J Manag Care. 2022 Oct 1;28(10):e378-e387. doi: 10.37765/ajmc.2022.89255.
To assess long-term adherence to oral hypoglycemic agents (OHAs) and determine if adherence affects total health care expenditures of reactive vs preventive services.
Retrospective cohort study.
This study measured adherence to OHAs using Medical Expenditure Panel Survey 2013-2017 data. Adults 65 years and older who had diabetes and were taking at least 1 OHA were included. Respondents with a medication possession ratio (MPR) of at least 80% were considered adherent. Health care utilization and expenditure were compared among adherent and nonadherent respondents for preventive and reactive services. Utilization data were analyzed using negative binomial regression and expenditure data using γ-family generalized linear regression models.
Approximately 67% of the cohort (n = 1279) were adherent. The adherent group had greater health care expenditure overall than nonadherent respondents ($29,985 [95% CI, $27,161-$32,743] vs $24,623 [95% CI, $21,623-$28,122]; P < .05). Although expenditure was higher for prescription medications and office visits, mean emergency department expenditures were higher for adherent respondents. The utilization and proportion of expenditure on preventive vs reactive health care services did not differ by adherence as defined by an MPR of at least 80%.
Increasing adherence provides an opportunity to improve CMS quality ratings. Our finding that adherence does not affect the financial burden of disease might be explained by the increased costs of preventive medication and increased comorbidity burden of these patients. Low adherence to OHAs encourages clinicians to be more proactive in ensuring that prescription medications are refilled regularly. By emphasizing equitable diabetes education and tailoring quality initiatives that minimize racial disparities, adherence can be better achieved.
评估口服降糖药（OHA）的长期依从性，并确定依从性是否会影响反应性与预防性服务的总医疗保健支出。
回顾性队列研究。
本研究使用 2013-2017 年医疗支出调查（MEPS）数据来衡量 OHA 的依从性。纳入年龄≥65 岁且至少服用 1 种 OHA 的糖尿病患者。药物使用比例（MPR）≥80%的患者被认为是依从的。比较依从性和非依从性患者的预防性和反应性服务的医疗保健利用和支出。利用负二项回归分析利用数据，利用 γ 族广义线性回归模型分析支出数据。
队列中约 67%（n=1279）的患者是依从的。与非依从性患者相比，依从性患者的整体医疗保健支出更高（29985 美元[95%CI，27161-32743]比 24623 美元[95%CI，21623-28122]；P<.05）。尽管处方药和就诊的支出较高，但依从性患者的急诊支出均值更高。根据 MPR 至少为 80%的标准，依从性并未影响预防与反应性保健服务的利用和支出比例。
提高依从性为改善医疗保险和医疗补助服务中心（CMS）质量评级提供了机会。我们发现依从性不会影响疾病的经济负担，这可能是由于预防性药物成本增加以及这些患者合并症负担增加所致。OHA 的低依从性促使临床医生更加积极主动地确保定期补充处方药。通过强调公平的糖尿病教育并制定最大限度减少种族差异的质量计划，可以更好地实现依从性。
