医疗保险D部分药物治疗管理对阿尔茨海默病及相关痴呆症患者抗痴呆药物依从性种族/民族差异的影响：一项观察性研究。
Effects of Medicare Part D medication therapy management on racial/ethnic disparities in adherence to antidementia medications among patients with Alzheimer's disease and related dementias: An observational study.
作者信息
Dong Xiaobei, Tsang Chi Chun Steve, Wan Jim Y, Chisholm-Burns Marie A, Finch Christopher K, Tsao Jack W, Browning Jamie A, Garuccio Joseph, Zeng Rose, Wang Junling
机构信息
Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA.
Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN 38163, USA.
出版信息
Explor Res Clin Soc Pharm. 2024 Feb 10;13:100420. doi: 10.1016/j.rcsop.2024.100420. eCollection 2024 Mar.
BACKGROUND
Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias.
OBJECTIVES
This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias.
METHODS
This is a retrospective analysis of 100% of 2010-2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities.
RESULTS
Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65-0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63-0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57-0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67-0.99).
DISCUSSION
The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias.
CONCLUSIONS
Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.
背景
关于医疗保险药物治疗管理（MTM）对阿尔茨海默病及相关痴呆症患者药物依从性方面种族/民族差异的影响，证据稀少。
目的
本研究考察了医疗保险MTM项目对阿尔茨海默病及相关痴呆症患者抗痴呆药物依从性方面种族/民族差异的影响。
方法
这是一项对2010 - 2017年与地区卫生资源档案相关联的医疗保险A、B、D部分100%数据的回顾性分析。研究结局为抗痴呆药物不依从，干预定义为2017年新加入MTM项目。进行倾向得分匹配以创建具有可比特征的干预组和对照组。采用差分模型及逻辑回归，包括干预组和种族/民族少数群体虚拟变量的交互项。
结果
未经调整的比较显示，2016年黑人、西班牙裔和亚太岛民患者比非西班牙裔白人患者更易出现不依从情况。干预组中黑人和白人患者不依从几率的差异在2017年比2016年降低了27%（比值比[OR]：0.73，95%置信区间[CI]：0.65 - 0.82）。西班牙裔和白人患者之间也有类似的26%的降低（OR：0.74，95% CI：0.63 - 0.87）。加入MTM项目与黑 - 白患者不依从差异降低33%（OR：0.67，95% CI：0.57 - 0.78）以及西班牙裔 - 白患者不依从差异降低19%（OR：0.81，95% CI：0.67 - 0.99）相关。
讨论
医疗保险MTM项目与阿尔茨海默病及相关痴呆症人群中黑人和白人患者之间、西班牙裔和白人患者之间抗痴呆药物依从性差异降低相关。
结论
扩大MTM项目可能对阿尔茨海默病及相关痴呆症护理中的种族/民族少数群体特别有益。
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