Kleinman Analytic Solutions, LLC, Philadelphia, PA, United States of America.
Managed Care Health Outcomes, CSL Vifor, Redwood City, CA, United States of America.
PLoS One. 2023 Mar 27;18(3):e0281775. doi: 10.1371/journal.pone.0281775. eCollection 2023.
Hyperkalemia is a frequent and serious complication in chronic kidney disease (CKD) that can impede continuation of beneficial evidence-based therapies. Recently, novel therapies such as patiromer have been developed to treat chronic hyperkalemia, but their optimal utility hinges on adherence. Social determinants of health (SDOH) are critically important and can impact both medical conditions and treatment prescription adherence. This analysis examines SDOH and their influence on adherence to patiromer or abandonment of prescriptions for hyperkalemia treatment.
This was an observational, retrospective, real-world claims analysis of adults with patiromer prescriptions and 6- and 12-months pre- and post-index prescription data in Symphony Health's Dataverse during 2015-2020, and SDOH from census data. Subgroups included patients with heart failure (HF), hyperkalemia-confounding prescriptions, and any CKD stages. Adherence was defined as >80% of proportion of days covered (PDC) for ≥60 days and ≥6 months, and abandonment as a portion of reversed claims. Quasi-Poisson regression modeled the impact of independent variables on PDC. Abandonment models used logistic regression, controlling for similar factors and initial days' supply. Statistical significance was p<0.05.
48% of patients at 60 days and 25% at 6 months had a patiromer PDC >80%. Higher PDC was associated with older age, males, Medicare/Medicaid coverage, nephrologist prescribed, and those receiving renin-angiotensin-aldosterone system inhibitors. Lower PDC correlated with higher out-of-pocket cost, unemployment, poverty, disability, and any CKD stage with comorbid HF. PDC was better in regions with higher education and income.
SDOH (unemployment, poverty, education, income) and health indicators (disability, comorbid CKD, HF) were associated with low PDC. Prescription abandonment was higher in patients with prescribed higher dose, higher out-of-pocket costs, those with disability, or designated White. Key demographic, social, and other factors play a role in drug adherence when treating life-threatening abnormalities such as hyperkalemia and may influence patient outcomes.
高钾血症是慢性肾脏病（CKD）的一种常见且严重的并发症，可能会阻碍有益的循证治疗的继续。最近，已经开发出了新型疗法，如帕替罗尔，用于治疗慢性高钾血症，但这些疗法的最佳应用取决于患者的坚持。健康的社会决定因素（SDOH）至关重要，它们会影响医疗状况和治疗方案的坚持。本分析考察了 SDOH 及其对帕替罗尔坚持或放弃高钾血症治疗方案的影响。
这是一项观察性、回顾性、真实世界的索赔分析，纳入了 2015 年至 2020 年期间 Symphony Health 的 Dataverse 中使用帕替罗尔处方的成年人，以及处方前 6 个月和后 12 个月的处方数据，以及来自人口普查数据的 SDOH。亚组包括心力衰竭（HF）患者、高钾血症混淆性处方患者和任何 CKD 阶段的患者。坚持定义为≥60 天和≥6 个月时的比例天数覆盖（PDC）>80%，放弃定义为部分反向索赔。准泊松回归模型分析了独立变量对 PDC 的影响。放弃模型使用逻辑回归，控制了类似的因素和初始天数的供应量。具有统计学意义的 p 值<0.05。
在第 60 天和第 6 个月时，分别有 48%和 25%的患者帕替罗尔 PDC>80%。更高的 PDC 与年龄较大、男性、医疗保险/医疗补助覆盖、肾内科医生开处方以及接受肾素-血管紧张素-醛固酮系统抑制剂有关。较低的 PDC 与较高的自付费用、失业、贫困、残疾和任何合并 HF 的 CKD 阶段相关。在教育程度和收入较高的地区，PDC 更好。
SDOH（失业、贫困、教育、收入）和健康指标（残疾、合并 CKD、HF）与低 PDC 相关。处方放弃率在开处方剂量较高、自付费用较高、残疾或指定为白人的患者中更高。关键的人口统计学、社会和其他因素在治疗危及生命的异常（如高钾血症）时会影响药物的坚持，并且可能会影响患者的结局。
