Classifying patients by antipsychotic adherence patterns using latent class analysis: Characteristics of nonadherent groups in the California Medicaid (Medi-Cal) program
Classifying patients by antipsychotic adherence patterns using latent class analysis: Characteristics of nonadherent groups in the California Medicaid (Medi-Cal) program
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DOI：
10.1111/j.1524-4733.2007.00214.x
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发表时间：
2008-01-01
期刊：
影响因子：
4.5
通讯作者：
Shi, Lizheng
中科院分区：
文献类型：
--
作者：
Ahn, Jeonghoon;McCombs, Jeffrey S.;Shi, Lizheng
目的：本研究通过对抗精神病药物治疗不同程度的依从性来确定潜在类别，并检查与每个依从性类别成员相关的社会人口统计学、临床和资源利用相关性。患者水平的数据来自1994年至2003年，100%样本的加州医疗补助按服务付费的精神分裂症患者索赔数据（36 195人）。然后使用1999年1月1日之后首次服用抗精神病药物的日期将每个患者的数据分为6个月的索引前（基线）和12个月的索引后（随访）期。三个分类依从性指标-药物拥有率大于0.80的二分变量，抗精神病药物治疗尝试的次数和抗精神病药物改变的时间-和两个协变量-治疗持续时间的分类变量和多药治疗的二分变量-用于潜在类模型。三级模型返回的所有信息标准的最低值，因此解释如下：潜伏类的患病率为1）14.8%的依从性; 2）部分粘连者20.7%; 3）未粘连者64.5%。非依从性类别的成员资格与少数民族、女性、因福利状况而合格、既往住院和既往治疗次数较多相关。在部分遵守类成员与较高的使用门诊，较高的储库抗精神病药物的使用率，和polypharmacy.Conclusion：多个指标的坚持抗精神病药物治疗，可用于定义类的坚持，与患者的特点和不同的模式，以前的医疗保健使用。
Objectives: This study identifies latent classes defined by varying degrees of adherence to antipsychotic drug therapy and examines the sociodemographic, clinical, and resource utilization correlates associated with membership in each adherence class.Data and methods: Patient-level data were drawn from the 1994 to 2003, 100%-sample California Medicaid fee-for-service paid claims data for patients with schizophrenia (N = 36,195). The date of the first antipsychotic medication filled after January 1, 1999 was then used to divide each patient's data into a 6-month preindex (baseline) and a 12-month postindex (follow-up) period. Three categorical adherence indicators-a dichotomous variable of medication possession ratio greater than 0.80, the number of antipsychotic treatment attempts, and time to a change in antipsychotic medications-and two covariates-a categorical variable of duration of therapy and a dichotomous variable of polypharmacy-were used in the latent class model.Results: A three-class model returned the lowest values for all the information criteria and was therefore interpreted as follows: The prevalence rates of the latent classes were 1) 14.8% for the adherent; 2) 20.7% for the partially adherent; and 3) 64.5% for the nonadherent. Membership in the nonadherent class was associated with minority ethnicity, being female, eligibility due to welfare status, prior hospitalizations, and a higher number of prior treatment episodes. Membership in the partially adherent class was associated with higher use of outpatient care, higher rates of depot antipsychotic drug use, and polypharmacy.Conclusion: Multiple indicators of adherence to antipsychotic medication can be used to define classes of adherence that are associated with patient characteristics and distinct patterns of prior health-care use.