与无家可归成年人进入永久性支持性住房相关的药物利用和依从性的变化。
Changes in Medication Utilization and Adherence Associated with Homeless Adults' Entry into Permanent Supportive Housing.
机构信息
Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Public Health Sciences, UNC Charlotte, Charlotte, NC, USA.
出版信息
J Gen Intern Med. 2024 Jul;39(9):1590-1596. doi: 10.1007/s11606-024-08621-0. Epub 2024 Jan 23.
BACKGROUND
Permanent supportive housing (PSH) programs, which have grown over the last decade, have been associated with changes in health care utilization and spending. However, little is known about the impact of such programs on use of prescription drugs critical for managing chronic diseases prevalent among those with unstable housing.
OBJECTIVE
To evaluate the effects of PSH on medication utilization and adherence among Medicaid enrollees in Pennsylvania.
DESIGN
Difference-in-differences study comparing medication utilization and adherence between PSH participants and a matched comparison cohort from 7 to 18 months before PSH entry to 12 months post PSH entry.
SUBJECTS
Pennsylvania Medicaid enrollees (n = 1375) who entered PSH during 2011-2016, and a propensity-matched comparison cohort of 5405 enrollees experiencing housing instability who did not receive PSH but received other housing services indicative of episodic or chronic homelessness (e.g., emergency shelter stays).
MAIN MEASURES
Proportion with prescription fill, mean proportion of days covered (PDC), and percent adherent (PDC ≥ 80%) for antidepressants, antipsychotics, anti-asthmatics, and diabetes medications.
KEY RESULTS
The PSH cohort saw a 4.77% (95% CI 2.87% to 6.67%) relative increase in the proportion filling any prescription, compared to the comparison cohort. Percent adherent among antidepressant users in the PSH cohort rose 7.41% (95% CI 0.26% to 14.57%) compared to the comparison cohort. While utilization increased in the other medication classes among the PSH cohort, differences from the comparison cohort were not statistically significant.
CONCLUSIONS
PSH participation is associated with increases in filling prescription medications overall and improved adherence to antidepressant medications. These results can inform state and federal policy to increase PSH placement among Medicaid enrollees experiencing homelessness.
背景
永久性支持性住房（PSH）项目在过去十年中不断发展，其与医疗保健的利用和支出的变化相关。然而，对于此类项目对管理不稳定住房人群中常见慢性疾病的关键处方药使用的影响，知之甚少。
目的
评估宾夕法尼亚州医疗补助计划参保者接受 PSH 对药物使用和依从性的影响。
设计
在 PSH 入住前 7 至 18 个月至 PSH 入住后 12 个月期间，采用差异中的差异研究比较 PSH 参与者与匹配的对照组之间的药物使用和依从性。
研究对象
宾夕法尼亚州医疗补助计划参保者（n = 1375），于 2011-2016 年入住 PSH，以及未入住 PSH 但接受其他住房服务（如紧急避难所住宿）的 5405 名不稳定住房参保者的倾向匹配对照组。
主要测量指标
抗抑郁药、抗精神病药、抗哮喘药和糖尿病药物的处方填写比例、平均覆盖天数比例（PDC）和服药遵从性比例（PDC≥80%）。
主要结果
PSH 队列的总体处方填写比例相对增加了 4.77%（95%CI 2.87%至 6.67%），而对照组则相对减少。PSH 队列中抗抑郁药使用者的服药遵从性提高了 7.41%（95%CI 0.26%至 14.57%），而对照组则相对减少。虽然 PSH 队列中其他药物类别中的利用率增加，但与对照组相比，差异无统计学意义。
结论
参与 PSH 与整体处方药物的使用增加以及抗抑郁药物的依从性提高有关。这些结果可以为州和联邦政策提供信息，以增加医疗补助计划参保者中无家可归者的 PSH 安置。
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