Department of Medicine.
Harris School of Public Policy.
Med Care. 2023 Dec 1;61(12 Suppl 2):S139-S146. doi: 10.1097/MLR.0000000000001894. Epub 2023 Nov 9.
Cost-related medication nonadherence (CRN) is an important patient-centered outcome measure. Longitudinal follow-up of CRN is rare.
We propose to develop a novel integrated dataset to study CRN longitudinally.
A dataset of 2000 Medicare beneficiaries at high risk of hospitalization surveyed quarterly on CRN and followed up individually for 8 quarters between 2013 and 2018 was linked to Medicare files. A metric of CRN categorizing persistent, intermittent, and transient CRN during the 8 quarters was developed. An ordered logit model and a logit model were developed to assess the factors influencing CRN overall and persistent CRN, respectively.
A total of 1761 patients were included in the analysis, among whom 869 (49.3%) reported CRN at least once in the 8-quarter study period, 178 (10%) reported persistent CRN, 395 (22.4%) reported intermittent CRN, and 296 (16.8%) reported transient CRN. The conditional effect in the logit model for persistent CRN revealed that baseline dual eligibility was negatively associated (adjusted odds ratio = 0.45, P < 0.01) and depression positively associated (adjusted odds ratio = 1.55, P = 0.01) with persistent CRN. The marginal analysis in the ordered logit model revealed a clear pattern of higher probabilities of persistent and intermittent CRN at younger ages while transient CRN was flat. Among the 252 subjects who were deceased, 31 (12.3%) reported persistent CRN, compared with 147 (9.74%) who were alive (P = 0.21 by χ2 test).
A significant number of patients reported persistent CRN, including those who were at the end of life. Research is critically needed to understand behavioral patterns among the younger Medicare population.
与费用相关的药物不依从（CRN）是一个重要的以患者为中心的结果衡量标准。对 CRN 的纵向随访很少见。
我们提出建立一个新的综合数据集来进行 CRN 的纵向研究。
对 2000 名有住院高风险的医疗保险受益人进行调查，每季度调查一次与费用相关的药物不依从情况，并在 2013 年至 2018 年期间对其进行 8 个季度的个体随访，将调查数据与医疗保险文件相链接。开发了一种衡量 CRN 的指标，用于在 8 个季度内分类持续性、间歇性和短暂性 CRN。分别建立有序逻辑模型和逻辑模型来评估影响总体 CRN 和持续性 CRN 的因素。
共纳入 1761 例患者进行分析，其中 869 例（49.3%）在 8 个季度的研究期间至少有一次报告 CRN，178 例（10%）报告持续性 CRN，395 例（22.4%）报告间歇性 CRN，296 例（16.8%）报告短暂性 CRN。逻辑模型中对持续性 CRN 的条件效应显示，基线双重资格与持续性 CRN 呈负相关（调整后的优势比=0.45，P<0.01），抑郁与持续性 CRN 呈正相关（调整后的优势比=1.55，P=0.01）。有序逻辑模型中的边际分析显示，在年轻患者中，持续性和间歇性 CRN 的概率更高，而短暂性 CRN 则保持不变。在 252 例死亡患者中，有 31 例（12.3%）报告持续性 CRN，而在存活的 147 例患者中，有 147 例（9.74%）报告持续性 CRN（χ2检验，P=0.21）。
相当数量的患者报告了持续性 CRN，包括生命末期的患者。迫切需要研究来了解 Medicare 年轻人群中的行为模式。
