The Impact of Medicare Part D on Medication Adherence Among Older Adults Enrolled in Medicare-Advantage Products
The Impact of Medicare Part D on Medication Adherence Among Older Adults Enrolled in Medicare-Advantage Products
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DOI：
10.1097/mlr.0b013e3181d68978
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发表时间：
2010-05-01
期刊：
影响因子：
3
通讯作者：
Newhouse, Joseph P.
中科院分区：
文献类型：
--
作者：
Zhang, Yuting;Lave, Judith R.;Newhouse, Joseph P.
目的：评估联邦医疗保险D部分对参加联邦医疗保险优势产品的高脂血症、高血压和/或糖尿病受益人的服药依从性的影响。研究设计：我们采用准实验前设计，包括3个治疗组和一个对照组，以评估D部分对几种处方药依从性的影响。研究对象：65岁或以上的高脂血症、高血压、高血压、和/或糖尿病在2004至2007年间连续参加宾夕法尼亚州一家大型保险公司的Medicare Advantage产品。衡量标准：药物拥有比率(MPR)，良好遵守MPR>；结果：D部分使高脂血症、糖尿病和高血压患者的MPR分别提高了13.4个百分点(95%CI，10.1~16.8)、17.9个百分点(95%CI，13.7~22.1)和13.5(95%CI，11.5~15.5)。依从性改善较少的其他两组与以前的药物益处有限。虽然在D部分之后，干预组中达到良好依从性水平的受益者比例有所增加，但高脂血症、糖尿病和高血压患者中分别不到50%、68%和78%的受益者获得了良好的依从性。结论：D部分增加了对降低高血压、糖尿病和高脂血症患者心血管事件风险的药物的依从性。从长远来看，这应该会改善老年人的健康。
Background: Little is known about how Medicare Part D affects the medication refill adherence for cardiovascular and diabetes medications, particularly among beneficiaries without prior drug coverage.Objectives: To evaluate Medicare Part D's effect on medication adherence among beneficiaries with hyperlipidemia, hypertension, and/or diabetes enrolled in Medicare Advantage products.Research Design: We used a quasi-experimental pre-post design, with 3 treatment groups and a comparison group, to assess the effect of Part D on several measures of adherence to prescription medications.Subjects: Adults aged 65 or older with hyperlipidemia, hypertension, and/or diabetes in 2003 continuously enrolled between 2004 and 2007 in a large Pennsylvania insurer's Medicare Advantage products.Measures: Medication possession ratios (MPR), good adherence with MPR > 0.8, and intensity of treatment measured by average daily counts of pills per day of treatment.Results: Part D improved MPRs in the group without prior drug coverage by 13.4 percentage points (95% CI, 10.1-16.8), 17.9 (95% CI, 13.7-22.1), and 13.5 (95% CI, 11.5-15.5) for those with hyperlipidemia, diabetes, and hypertension, respectively. Adherence improved less in the other 2 groups with limited prior drug benefits. Although the proportion of beneficiaries in the intervention groups who attained good adherence levels increased after Part D, less than 50%, 68%, and 78% of beneficiaries with hyperlipidemia, diabetes, and hypertension, respectively, attained good adherence.Conclusion: Part D increased adherence to medications that reduce the risk of cardiovascular events for patients with hypertension, diabetes, and hyperlipidemia. This should improve the health of the elderly people in the long run.