Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America.
Harris School of Public Policy, The University of Chicago, Chicago, Illinois, United States of America.
PLoS One. 2023 Aug 29;18(8):e0289608. doi: 10.1371/journal.pone.0289608. eCollection 2023.
To study cost-related medication non-adherence (CRN) for a 30-month period before and during the COVID-19 pandemic using a sample of Medicare patients at high risk of hospitalization.
A novel data set of quarterly surveys of CRN was used to evaluate CRN before and during the COVID-19 pandemic. Generalized Estimating Equation (GEE) analyses were conducted to evaluate the adjusted coefficients of change in CRN behaviors controlling for socio-demographic and health characteristics.
Six hundred seventy-seven Medicare beneficiaries at high risk of hospitalization who were alive on January 1, 2020 and followed up through quarterly surveys on CRN for 30 months before and during the COVID-19 pandemic.
Two metrics of prevalence and persistence of CRN and their adjusted coefficients in GEE with binomial family distribution and log link function controlling for socio-demographic and health characteristics.
A total of 5,990 quarterly surveys were completed by the 677 patients during the 30-month study period. Among the 677 patients, 250 (37%) were men, 591 (87%) were African American, and 288 (42%) were Medicare-Medicaid dual eligible. The unadjusted prevalence of CRN before and during the COVID-19 pandemic was 31.1% and 25.7% respectively (p = 0.02 by Chi-squared test), and persistent CRN rates were 12.1% and 9.7% respectively (p = 0.17 by Chi-squared test). The adjusted odds ratio of CRN prevalence during the pandemic compared to the pre-pandemic level was 0.75 (p<0.01), and 0.74 (p = 0.03) for persistent CRN in GEE estimations.
There are coherent evidence of a reversal of CRN rates during the COVID-19 pandemic among this high-need, high-cost resource utilization Medicare population. Patients' CRN behaviors may be responsive to exogenous impacts, and the behaviors changed in the same direction with similar magnitude in terms of prevalence (the extensive margin) and persistence (the intensive margin). More research is needed to advance the understanding of the driving forces behind patients' behavioral changes and to identify factors that may be informative for reducing CRN in the long run.
利用一组有住院高风险的医疗保险患者的样本，研究 COVID-19 大流行前后 30 个月期间与费用相关的药物不依从（CRN）。
使用一个季度调查的新型数据集，评估 COVID-19 大流行前后的 CRN。采用广义估计方程（GEE）分析，在控制社会人口统计学和健康特征的情况下，评估 CRN 行为的调整变化系数。
2020 年 1 月 1 日存活且在 COVID-19 大流行前后 30 个月内接受 CRN 季度调查的 677 名有住院高风险的医疗保险受益人。
采用二项式家族分布和对数链接函数的广义估计方程（GEE），控制社会人口统计学和健康特征，评估 CRN 的两种流行率和持续性指标及其调整系数。
在 30 个月的研究期间，677 名患者共完成了 5990 次季度调查。在 677 名患者中，250 名（37%）为男性，591 名（87%）为非裔美国人，288 名（42%）为医疗保险-医疗补助双重资格。COVID-19 大流行前后的未调整 CRN 流行率分别为 31.1%和 25.7%（卡方检验，p = 0.02），持续性 CRN 率分别为 12.1%和 9.7%（卡方检验，p = 0.17）。与大流行前相比，大流行期间 CRN 的调整优势比为 0.75（p<0.01），GEE 估计中持续性 CRN 为 0.74（p = 0.03）。
在这一高需求、高成本资源利用的医疗保险人群中，有一致的证据表明 COVID-19 大流行期间 CRN 率出现逆转。患者的 CRN 行为可能对外生影响有反应，并且行为在流行率（广泛边际）和持续性（密集边际）方面以相似的幅度朝着相同的方向变化。需要进一步研究，以加深对患者行为变化背后驱动力的理解，并确定从长远来看可能有助于降低 CRN 的因素。
