Utilization of, and adherence to, drug therapy among medicaid beneficiaries with congestive heart failure
Utilization of, and adherence to, drug therapy among medicaid beneficiaries with congestive heart failure
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DOI：
10.1016/j.clinthera.2007.08.015
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发表时间：
2007-08-01
影响因子：
3.2
通讯作者：
Bencio, Deo
中科院分区：
文献类型：
--
作者：
Bagchi, Ann D.;Esposito, Dominick;Bencio, Deo
背景：充血性心力衰竭(CHF)影响着480万美国成年人，尤其是65岁的老年人，由于这种疾病每年的高发病率(估计每年新增55万例)，CHF被描述为一种新的流行病。目的：本研究的目标是确定CHF的医疗补助受益人的数量，确定CHF的药物使用率，估计依从率，检查与CHF药物使用和依从性相关的因素，并探索研究结果的政策含义。方法：使用的方法包括利用>；=1名住院患者索赔或：2份确诊为CHF的动态索赔，以及使用1998年州医疗补助研究文件和1999年阿肯色州、加利福尼亚州、印第安纳州和新泽西州医疗补助分析摘录数据的CHF药物索赔。用药物持有率(MPR)和用药持续天数评估患者的依从性。结果：总体而言，84.8%的受益人声称至少服用了一种CHF药物；15.2%的受益人没有使用任何CHF药物。在有申索的人中，平均每月有1.4宗申索，25.8%的人每月有4宗申索。平均MPR为71.9%，平均每月用药天数为24.8天。65岁人群、男性、少数民族、非CHF住院患者以及慢性病和残障支付系统得分较高的受益人不太可能提出CHF药物申请，并且遵从率较低。结论：国家医疗补助机构和医疗保险处方药计划应该考虑设计有针对性的干预措施，鼓励CHF的医疗补助受益人，特别是男性、65岁的老年人、少数民族和整体健康状况较差的患者更好地遵守。(CLIN THER.2007；29：1771-1783)版权所有(C)2007 Excerpta Medica，Inc.
Background: Congestive heart failure (CHF) affects 4.8 million adult Americans, particularly those aged > 65 years, and has been described as a "new epidemic" due to the high annual incidence of the disease (an estimated 550,000 new cases per year).Objectives: The goal of this research was to determine the number of Medicaid beneficiaries with CHF, identify the rate of CHF drug use, estimate adherence rates, examine factors associated with CHF drug use and adherence, and explore policy implications of the research findings.Methods: Methods used included identifying non-institutionalized beneficiaries with >= 1 inpatient claim or :2 ambulatory claims with a CHF diagnosis and claims for CHF drugs using 1998 State Medicaid Research Files and 1999 Medicaid Analytic extract data for Arkansas, California, Indiana, and New Jersey. Patient adherence was estimated using the medication possession ratio (MPR) and days of medication persistence. Multivariate regression models were used to identify factors associated with CHF drug use and adherence.Results: Overall, 84.8% of beneficiaries had claims for at least 1 CHF medication; 15.2% of beneficiaries were not using any CHF medications. Among those with a claim, the mean number of claims per month was 1.4, and 25.8% had 4 claims per month. Mean MPR was 71.9% and mean days of medication persistence were 24.8 per month. Persons aged < 65 years, men, ethnic minorities, patients with hospital admissions for conditions other than CHF, and beneficiaries with high Chronic Illness and Disability Payment System scores were less likely to have a CHF drug claim and had lower adherence rates.Conclusions: State Medicaid agencies and Medicare prescription drug plans should consider designing targeted interventions that encourage better adherence among Medicaid beneficiaries with CHF, particularly men, those aged < 65 years, ethnic minorities, and patients with poor overall health status. (Clin Ther. 2007;29:1771-1783) Copyright (c) 2007 Excerpta Medica, Inc.