Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims.
Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims.
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DOI：
10.1371/journal.pone.0249453
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Greenwood BN
中科院分区：
文献类型：
--
作者：
Clement J;Jacobi M;Greenwood BN
患者获得和坚持慢性药物治疗至关重要。在这项工作中，我们评估了与COVID-19相关的中断是否影响了新的和现有的患者在不中断的情况下获得药物治疗。我们对2019年5月至2020年8月期间2.52亿患者的94亿份美国处方药索赔数据集进行了回顾性分析（约93%的处方在这几个月内分发）。使用固定效应（条件似然）线性模型，我们评估了护理的连续性，患者接受了多少天的供应，以及对人群健康有重大影响的药物类停止治疗的可能性。调查结果显示，2020年3月的处方量比之前任何一个月都多，随后每月配药量大幅下降。与新冠肺炎前相比，新冠肺炎传播后，患者停用某些药物的可能性增加：炔雌醇-炔雌醇（激素避孕药）停药增加0.62%（95% CI：0.59%至0.65%，p<0.001）;盐酸右哌甲酯（ADHD兴奋剂治疗）停药增加2.84%（95% CI：2.79%至2.89%，p<0.001）;草酸艾司西酞普兰（SSRI抗抑郁药）停药增加0.57%（95% CI：0.561%至0.578%，p<0.001）;氟哌啶醇（抗精神病药）停药增加1.49%（95% CI：1.41%至1.57%，p<0.001）。相反，停用他克莫司（免疫抑制剂）的可能性降低0.15%（95% CI：0.12%至0.19%，p<0.001）。停用丁丙诺啡/纳洛酮（阿片类药物成瘾治疗）的可能性降低0.59%（95% CI：0.55%至0.62%降低，p<0.001）。我们还观察到接受后两种治疗的新患者明显减少。大多数美国患者在新冠肺炎疫情的最初几个月能够获得慢性药物，但与前几个月相比，他们更有可能停止治疗。此外，开始服用可能对他们的护理至关重要的药物的新患者比正常人少。提供者最好询问依从性，并提供及时的，非判断性的，重新开始药物治疗。从政策的角度来看，阿片类药物管理计划似乎表现出强大的能力，尽管中断管理现有的患者。
Patient access and adherence to chronic medications is critical. In this work, we evaluate whether disruptions related to Covid-19 have affected new and existing patients’ access to pharmacological therapies without interruption. We do so by performing a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients from May, 2019 through August, 2020 (about 93% of prescriptions dispensed within those months). Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts. Findings indicate that more prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in monthly dispensing. Compared to the pre-Covid era, a patient’s likelihood of discontinuing some medications increased after the spread of Covid: norgestrel-ethinyl estradiol (hormonal contraceptive) discontinuation increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD stimulant treatment) discontinuation increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI antidepressant) discontinuation increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) discontinuation increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in new patients accessing these latter two therapies. Most US patients were able to access chronic medications during the early months of Covid-19, but still were more likely to discontinue their therapies than in previous months. Further, fewer than normal new patients started taking medications that may be vital to their care. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.
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影响因子：
5.5
作者：
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DOI：
10.1017/s1461145712001277
发表时间：
2013-07
期刊：
The international journal of neuropsychopharmacology
影响因子：
--
作者：
Zhang JP;Gallego JA;Robinson DG;Malhotra AK;Kane JM;Correll CU
通讯作者：
Correll CU