Prevalence and Persistence of Cost-Related Medication Nonadherence Among Medicare Beneficiaries at High Risk of Hospitalization.
Prevalence and Persistence of Cost-Related Medication Nonadherence Among Medicare Beneficiaries at High Risk of Hospitalization.
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DOI：
10.1001/jamanetworkopen.2021.0498
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发表时间：
2021-03-01
影响因子：
13.8
通讯作者：
Zhang JX
中科院分区：
文献类型：
--
作者：
De Avila JL;Meltzer DO;Zhang JX
这项队列研究评估了住院风险高的医疗保险受益人中成本相关药物不依从（CRN）的患病率和持续性，以及该人群中与CRN相关的特征。在住院风险高的医疗保险受益人中，高成本、高需求资源利用的人群中，成本相关药物不依从（CRN）的患病率和持续性如何？CRN随时间的纵向模式是什么？在这项对1655名医疗保险受益人的队列研究中，CRN的人群调整患病率为53.6%，在15个月的研究期间，至少报告一次CRN的患者中有28.4%有持续的CRN。年龄较小、自我报告的健康状况较差和抑郁症与持续性CRN的可能性更大相关。研究结果表明，CRN是普遍存在的，中度持久性，并在医疗保险人群中的高风险住院，尽管保险覆盖的变量。药物负担不起一直是美国医疗保健系统面临的一个持久而难以捉摸的挑战。在高成本、高需求资源利用的人群中，成本相关用药不依从（CRN）的患病率和持续性知之甚少。评估住院风险高的医疗保险受益人中CRN的患病率和持续性，以及该人群中与CRN相关的特征。这项队列研究使用了2012年11月6日至2018年1月30日在城市学术医疗中心住院风险高且预期寿命超过12个月的医疗保险患者的调查数据。患者从基线起每隔3个月随访12个月，共进行5次调查。数据分析时间为2020年9月1日至2021年1月5日。自我报告的CRN，使用持久性和短暂性指标。根据5次调查的结果，CRN被分类为持续性（3次或更多次调查）、间歇性（2次）、一过性（1次）和任何（1次或更多次）。多元逻辑回归分析用于评估与持续性和短暂性CRN相关的因素。在15个月研究期间随访的1655名医疗保险受益人中，1036名（62.6%）为女性，1452名（87.7%）为黑人或非裔美国人; 769名（46.5%）年龄小于65岁，886名（53.5%）年龄≥ 65岁（平均[SD]年龄为62.4 [15.9]岁）。共有374例患者（22.6%）在基线时报告了CRN，810例（48.9%）报告了任何CRN，230例（13.9%）报告了持续性CRN（148例[19.2%]年龄小于65岁的患者和82例[9.3%]年龄≥ 65岁的患者）。在15个月的研究期间，230例持续性CRN患者占至少报告一次CRN患者的28%。低龄化（例如，<50岁vs 75岁：调整的比值比[AOR]，3.07; 95% CI，1.61 - 5.86; P =.001），自我报告的健康状况较差（AOR，1.59; 95%CI，1.10 - 2.31; P =.01）和抑郁（AOR，1.58; 95%CI，1.11 - 2.24; P =.01）与持续性CRN的可能性更大相关。人群校正的CRN患病率为53.6%（887例患者）。研究结果表明，CRN是普遍存在的，中度持久性，并在医疗保险人群中的高风险住院，尽管保险覆盖的变量。CRN的纵向随访和精细预测模型似乎需要更精确地识别和定位那些持续性CRN患者，并制定有效的干预措施。
This cohort study evaluates the prevalence and persistence of cost-related medication nonadherence (CRN) among Medicare beneficiaries at high risk of hospitalization as well as the characteristics associated with CRN in this population. What are the prevalence and persistence of cost-related medication nonadherence (CRN) among Medicare beneficiaries at high risk of hospitalization, a population with high-cost, high-need resource utilization, and what is the longitudinal pattern of CRN over time? In this cohort study of 1655 Medicare beneficiaries, the population-adjusted prevalence of CRN was 53.6%, and 28.4% of those who reported CRN at least once had persistent CRN during the 15-month study period. Younger age, worse self-reported health, and depression were associated with greater likelihood of persistent CRN. The findings suggest that CRN is prevalent, moderately persistent, and variable in the Medicare population at high risk of hospitalization despite coverage by insurance. The unaffordability of drugs has been a persistent and elusive challenge in the US health care system. Little is known about the prevalence and persistence of cost-related medication nonadherence (CRN) in a population with high-cost, high-need resource utilization. To evaluate the prevalence and persistence of CRN among Medicare beneficiaries at high risk of hospitalization as well as the characteristics associated with CRN in this population. This cohort study used survey data from Medicare patients at high risk of hospitalization and with a life expectancy greater than 12 months at an urban academic medical center from November 6, 2012, to January 30, 2018. Patients were followed up for 12 months at 3-month intervals from baseline, for a total of 5 surveys. Data were analyzed from September 1, 2020, to January 5, 2021. Self-reported CRN, using a metric of persistence and transiency. Based on the results of the 5 surveys, CRN was categorized as persistent (3 or more surveys), intermittent (2), transient (1), and any (1 or more). Multiple logistic regression analyses were used to evaluate factors associated with persistent and transient CRN. Of the 1655 Medicare beneficiaries followed up during the 15-month study period, 1036 (62.6%) were women and 1452 (87.7%) were Black or African American; 769 (46.5%) were younger than 65 years, and 886 (53.5%) were 65 years or older (mean [SD] age, 62.4 [15.9] years). A total of 374 patients (22.6%) reported CRN at baseline, 810 (48.9%) reported any CRN, and 230 (13.9%) reported persistent CRN (148 [19.2%] of those younger than 65 years and 82 [9.3%] of those 65 years or older). The 230 patients who had persistent CRN accounted for 28% of those who reported CRN at least once during the 15-month study period. Younger age (eg, <50 years vs 75 years: adjusted odds ratio [AOR], 3.07; 95% CI, 1.61-5.86; P = .001), worse self-reported health (AOR, 1.59; 95% CI, 1.10-2.31; P = .01), and depression (AOR, 1.58; 95% CI, 1.11-2.24; P = .01) were associated with greater likelihood of persistent CRN. The population-adjusted prevalence of CRN was 53.6% (887 patients). The findings suggest that CRN is prevalent, moderately persistent, and variable in the Medicare population at high risk of hospitalization despite coverage by insurance. Longitudinal follow-up and refined predictive modeling of CRN appear to be needed to identify and target more precisely those with persistent CRN and to develop effective interventions.
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