Liu Ligang, Almodóvar Armando Silva, Nahata Milap C
Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA.
College of Medicine, The Ohio State University, Columbus, OH 43210, USA.
J Clin Med. 2022 Nov 26;11(23):6985. doi: 10.3390/jcm11236985.
Medication adherence to controller inhalers was unknown in older Medicare patients with chronic obstructive pulmonary disease (COPD) before and during the pandemic. This study evaluated changes in medication adherence to controller medications and factors associated with high adherence. This retrospective cohort study included older Medicare patients with COPD. The proportion of days covered (PDC) reflected changes in medication adherence from January to July in 2019 and in 2020. Paired t-test evaluated changes in adherence. Logistic regression determined the association of patient characteristics with high adherence (PDC ≥ 80%). Mean adherence decreased (p < 0.001) for long-acting beta-agonists, long-acting muscarinic antagonists, and inhaled corticosteroids in 2020. The percentage of patients with high adherence dropped from 74.4% to 58.1% (p < 0.001). The number of controllers, having ≥3 albuterol fills, and a 90-day supply were associated with high adherence in 2019 and 2020 (p < 0.001). The COVID-19 pandemic may negatively impact medication adherence. Patients with evidence of more severe diseases and a 90-day supply were more likely to adhere to therapy. Healthcare professionals should prioritize prescribing 90-day supplies of medications and monitor drug-related problems as components of pharmacovigilance to enhance adherence to therapies and the desired clinical outcomes among patients with COPD.
在大流行之前和期间，老年医疗保险慢性阻塞性肺疾病（COPD）患者对控制吸入器的药物依从性情况尚不清楚。本研究评估了控制药物的药物依从性变化以及与高依从性相关的因素。这项回顾性队列研究纳入了老年医疗保险COPD患者。覆盖天数比例（PDC）反映了2019年和2020年1月至7月药物依从性的变化。配对t检验评估依从性变化。逻辑回归确定患者特征与高依从性（PDC≥80%）之间的关联。2020年，长效β受体激动剂、长效毒蕈碱拮抗剂和吸入性糖皮质激素的平均依从性下降（p<0.001）。高依从性患者的比例从74.4%降至58.1%（p<0.001）。2019年和2020年，使用控制药物的数量、沙丁胺醇填充量≥3次以及90天的药物供应量与高依从性相关（p<0.001）。COVID-19大流行可能对药物依从性产生负面影响。患有更严重疾病且有90天药物供应量的患者更有可能坚持治疗。医疗保健专业人员应优先开具90天药物供应量的处方，并监测药物相关问题，作为药物警戒的组成部分，以提高COPD患者对治疗的依从性和达到预期的临床效果。
