Construct Validity and Factor Structure of Survey-based Assessment of Cost-related Medication Burden
Construct Validity and Factor Structure of Survey-based Assessment of Cost-related Medication Burden
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DOI：
10.1097/mlr.0000000000000286
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发表时间：
2015-02-01
期刊：
影响因子：
3
通讯作者：
Harrington, Donna
中科院分区：
文献类型：
--
作者：
Burcu, Mehmet;Alexander, G. Caleb;Harrington, Donna
背景：数百万美国人负担着自付处方费用。虽然已经开发了许多调查措施来评估这一负担，但这些工具的结构效度和因素结构尚未得到严格评估。目的：探讨成本相关用药负担评估项目的因素结构和构效度。方法：采用探索性因子分析和验证性因子分析对2009年医疗保险现行受益人调查进行分析，重点评估了全国代表性的社区医疗保险受益人中与成本相关的调解负担。用几个指标比较了竞争模型的拟合。结果：研究人群（N = 8777）以65岁以上老人（83.3%）、女性（54.4%）、白人（84.3%）为主。药物成本降低策略存在两个明显的因素：(1)与费用相关的药物依从性和(2)药物购物行为，不直接影响药物依从性。这两个因素呈中度相关（r = 0.55），突出了与费用相关的药物负担存在两个不同但相关的结构。一项评估邮件或互联网药房使用情况的项目在这两项因素上都没有很好地加载，可能不一定衡量与药物有关的成本负担。一个评估基本需求支出减少的项目与与费用相关的药物不依从性项目在同一因素上加载强烈，表明它们可能共同代表可能对健康结果产生不利影响的极端代偿行为。结论：从这些检查费用相关药物负担的项目中得出两个不同的结构。尽管与费用相关的药物负担通常与不坚持用药有关，但不直接影响坚持用药的购药行为也是这种负担的重要衡量标准。
Background: Millions of Americans are burdened by out-of-pocket prescription costs. Although many survey measures have been developed to assess this burden, the construct validity and the factor structure of these instruments have not been rigorously assessed.Objectives: To characterize the factor structure and the construct validity of items assessing cost-related medication burden.Methods: We applied exploratory factor and confirmatory factor analyses to the 2009 Medicare Current Beneficiary Survey, focusing on 10 items assessing cost-related mediation burden among a nationally representative sample of community-dwelling Medicare beneficiaries. The fit of competing models was compared using several indices.Results: The study population (N = 8777) was predominantly aged over 65 years (83.3%), female (54.4%), and white (84.3%). Two distinct factors were present for the medication cost-reduction strategies: (1) cost-related medication nonadherence and (2) drug-shopping behaviors, not directly impacting medication compliance. The two factors were moderately correlated (r = 0.55), highlighting the presence of a 2 distinct but related constructs for cost-related medication burden. An item assessing the use of mail or internet pharmacies did not load well on either factor and may not necessarily measure medication-related cost burden. An item assessing reduced spending on basic needs loaded strongly on the same factor with the cost-related medication nonadherence items, suggesting they together may represent extreme compensatory behaviors that may adversely affect health outcomes.Conclusions: Two distinct constructs were derived from these items examining cost-related medication burden. Although cost-related medication burden is often associated with nonadherence, drug-shopping behaviors that do not directly impact adherence are also important measure of this burden.