Liu Ligang, Silva Almodóvar Armando, Nahata Milap C
Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio, USA.
Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, 500 West 12th Ave, Columbus, OH 43210, USA.
Ther Adv Chronic Dis. 2023 Oct 9;14:20406223231205796. doi: 10.1177/20406223231205796. eCollection 2023.
Medication adherence in Medicare-enrolled older adults with asthma and chronic obstructive pulmonary disease (COPD) before and during the coronavirus disease 2019 (COVID-19) pandemic is unknown.
To evaluate medication adherence and determinants of high adherence before and during the COVID-19 pandemic in this population.
Retrospective cohort study.
The proportion of days covered (PDC) reflected medication adherence from January to July 2019 and from January to July 2020. Patients <65 years of age, with COPD or asthma alone, or with cystic fibrosis were excluded. Paired tests were used to assess adherence changes. Logistic regression explored association of age, sex, diagnosis of depression, number of medications, medication-related problems, prescribers, pharmacies, controller medication classes, albuterol rescue inhaler fills, oral corticosteroid fills, and having a 90-day supply with high adherence (PDC ⩾ 80%).
This analysis included 989 patients. In this cohort, 61.2% of patients received oral corticosteroids. Over 60% of patients had ⩾3 rescue fills in both 2019 and 2020. Medication adherence to controller medications significantly decreased for all controller medications ( < 0.001) in 2020. In 2019 and 2020, number of controller medication classes and having a 90-day supply were associated with high adherence ( < 0.001). In 2019, variables associated with high adherence also included number of medication-related problems and having ⩾3 albuterol rescue inhalers ( < 0.001).
Medication adherence to controllers significantly decreased during the pandemic among older adults with asthma and COPD. Patients with multiple controller classes and a 90-day supply were more likely to be highly adherent. A 90-day supply of medications should be used to facilitate access to medication during the pandemic. Healthcare professionals should assess medication adherence, resolve the barriers of adherence and medication-related problems to achieve desired clinical outcomes among older adults with both asthma and COPD.
2019冠状病毒病（COVID-19）大流行之前及期间，参加医疗保险的老年哮喘和慢性阻塞性肺疾病（COPD）患者的药物依从性尚不清楚。
评估该人群在COVID-19大流行之前及期间的药物依从性及高依从性的决定因素。
回顾性队列研究。
覆盖天数比例（PDC）反映了2019年1月至7月以及2020年1月至7月的药物依从性。排除年龄<65岁、仅患有COPD或哮喘或患有囊性纤维化的患者。采用配对检验评估依从性变化。逻辑回归探讨了年龄、性别、抑郁症诊断、药物数量、药物相关问题、开处方者、药房、控制药物类别、沙丁胺醇急救吸入器填充量、口服糖皮质激素填充量以及拥有90天供应量与高依从性（PDC⩾80%）之间的关联。
该分析纳入了989名患者。在这个队列中，61.2%的患者接受了口服糖皮质激素治疗。2019年和2020年，超过60%的患者有⩾3次急救填充量。2020年，所有控制药物的控制药物依从性均显著下降（<0.001）。在2019年和2020年，控制药物类别数量和拥有90天供应量与高依从性相关（<0.001）。2019年，与高依从性相关的变量还包括药物相关问题数量以及拥有⩾3次沙丁胺醇急救吸入器（<0.001）。
在大流行期间，哮喘和COPD老年患者对控制药物的依从性显著下降。拥有多种控制药物类别和90天供应量的患者更有可能具有高依从性。应采用90天的药物供应量，以便在大流行期间方便患者获取药物。医疗保健专业人员应评估药物依从性，解决依从性障碍和药物相关问题，以在患有哮喘和COPD的老年患者中实现理想的临床结果。
