慢性阻塞性肺疾病医疗保险受益人的综合药物审查与药物依从性之间的关联。
The association between comprehensive medication review and medication adherence among medicare beneficiaries with chronic obstructive pulmonary disease.
作者信息
Zhang Xiangjun, Sim Yongbo, Tsang Chi Chun Steve, Wang Junling, Finch Christopher K
机构信息
Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA.
出版信息
Explor Res Clin Soc Pharm. 2024 Jun 24;15:100470. doi: 10.1016/j.rcsop.2024.100470. eCollection 2024 Sep.
BACKGROUND
Medicare Part D plans are required to provide Medication therapy management (MTM) services to eligible beneficiaries to optimize medication utilization. Comprehensive medication review (CMR) is a core element of the MTM program. Despite the availability of advanced medical treatment for patients with chronic obstructive pulmonary disease (COPD), medication adherence to maintenance medications poses a continued challenge for patients with COPD.
OBJECTIVE
To examine the effects of CMR on medication adherence among patients with COPD.
METHODS
Medicare data for 2016-2017 linked to Area Health Resource Files were analyzed. The study population was Medicare beneficiaries with COPD. The intervention group consisted of beneficiaries who received CMR in 2017 but not in 2016. Patients who were eligible for MTM services but did not receive these services in 2016 or 2017 made up the control group. Propensity score matching was used to select an intervention and control group with balanced characteristics. The study outcome was adherence to COPD medications with the proportion of days covered at or above 80%. A difference-in-differences approach was adopted in the logistic regression analyses with an interaction term between the status of CMR receipt and the year 2017.
RESULTS
The study sample included 25,564 patients with COPD. The proportions of adherent patients were similar in the control group in both years but increased significantly from 60.08% in 2016 to 69.38% in 2017 in the intervention group ( < .001). The odds of medication adherence in the intervention group increased from 2016 to 2017 by 59% more than in the control group (adjusted odds ratio = 1.59, 95% confidence interval = 1.48-1.71).
CONCLUSIONS
Receiving CMR was associated with improved adherence to COPD medications among Medicare beneficiaries. Policymakers should ensure that Medicare beneficiaries with COPD receive CMR.
背景
医疗保险D部分计划要求为符合条件的受益人提供药物治疗管理（MTM）服务，以优化药物使用。全面药物审查（CMR）是MTM计划的核心要素。尽管慢性阻塞性肺疾病（COPD）患者可获得先进的医疗治疗，但坚持使用维持药物对COPD患者来说仍是一个持续的挑战。
目的
研究CMR对COPD患者药物依从性的影响。
方法
分析了2016 - 2017年与地区卫生资源档案相关联的医疗保险数据。研究人群为患有COPD的医疗保险受益人。干预组由2017年接受CMR但2016年未接受的受益人组成。符合MTM服务条件但在2016年或2017年未接受这些服务的患者构成对照组。采用倾向得分匹配法选择特征均衡的干预组和对照组。研究结果是对COPD药物的依从性，以覆盖天数比例达到或超过80%来衡量。在逻辑回归分析中采用了差异中的差异方法，其中包括CMR接受状态与2017年之间的交互项。
结果
研究样本包括25564例COPD患者。对照组两年中依从性患者的比例相似，但干预组从2016年的60.08%显著增加到2017年的69.38%（P <.001）。干预组中药物依从性的几率从2016年到2017年比对照组增加了59%（调整后的优势比 = 1.59，95%置信区间 = 1.48 - 1.71）。
结论
接受CMR与医疗保险受益人中COPD药物依从性的改善相关。政策制定者应确保患有COPD的医疗保险受益人接受CMR。
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