Prescription drug benefits and use of guideline recommended medications by elderly Medicare beneficiaries with diabetes mellitus.
Prescription drug benefits and use of guideline recommended medications by elderly Medicare beneficiaries with diabetes mellitus.
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患有糖尿病的老年医疗保险受益人的处方药福利和指南推荐药物的使用。
DOI：
10.1111/j.1532-5415.2008.01917.x
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发表时间：
2008
影响因子：
6.3
通讯作者：
Briesacher,BeckyA
中科院分区：
文献类型：
--
作者：
Tjia,Jennifer;Briesacher,BeckyA
研究目的：确定处方药福利是否与2型糖尿病（DM）老年人使用指南推荐的药物有关。设计：横断面研究。参与者：参加2003年医疗保险当前福利调查的65岁及以上的DM患者和血管紧张素转换酶抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）使用适应症或冠心病高风险（高血压或当前吸烟）的医疗保险受益人的国家样本。测量：根据自我报告测量处方药覆盖范围，并根据保险索赔进行验证。结果变量为ACEI或ARB（ACEI/ARB）或他汀类药物的使用或ACEI/ARB和他汀类药物的使用。在控制了社会人口学特征和健康状况后，使用调查加权多项logistic回归来确定药物覆盖率对两类推荐药物使用之一（ACEI/ARB或他汀类药物或ACEI/ARB和他汀类药物）的独立影响，并与参考类别（无）进行比较。总体而言，23%的人没有药物覆盖，16%的医疗补助覆盖，43%的雇主覆盖，9%的Medigap覆盖，9%的退伍军人事务部（VA）或国家赞助的低收入覆盖。总体而言，33%接受他汀类药物和ACEI/ARB，44%仅接受ACEI/ARB或他汀类药物，23%两者都不接受。调整后，VA和国家资助的药物获益与ACEI/ARB和他汀类药物联合使用最密切相关（相对风险比（RRR）=4.83，95%置信区间（CI）=2.24-10.4）），其次是雇主赞助的保险（RRR=2.60，95% CI=1.67-4.03））。VA和国家赞助的药物计划的处方药获益与老年糖尿病患者使用推荐药物密切相关。
OBJECTIVES:To determine whether prescription drug benefits are associated with the use of guideline recommended medications by older persons with type 2 diabetes mellitus (DM).DESIGN:Cross‐sectional study.PARTICIPANTS:A national sample of Medicare beneficiaries with DM aged 65 and older and an indication for angiotensin‐converting enzyme inhibitor (ACEI) or angiotensin II–receptor blocker (ARB) use or high risk of coronary heart disease (hypertension or current smoking) who participated in the 2003 Medicare Current Beneficiary Survey.MEASUREMENTS:Prescription drug coverage was measured according to self‐report and verified according to insurance claims. Outcome variables were use of an ACEI or an ARB (ACEI/ARB) or a statin or use of an ACEI/ARB and a statin. Survey‐weighted multinomial logistic regression was used to identify the independent effect of drug coverage on one of two categories of recommended medication use (ACEI/ARB or statin or ACEI/ARB and statin) compared with the reference category of none after controlling for sociodemographic characteristics and health status.RESULTS:The final study sample was 1,181 (weighted N=4.0 million). Overall, 23% had no drug coverage, 16% Medicaid coverage, 43% employer coverage, 9% Medigap coverage, and 9% Department of Veterans Affairs (VA) or state‐sponsored low‐income coverage. Overall, 33% received a statin and an ACEI/ARB, 44% only an ACEI/ARB or a statin, and 23% neither. After adjustment, VA and state‐sponsored drug benefits were most strongly associated with combined ACEI/ARB and statin use (relative risk ratio (RRR)=4.83, 95% confidence interval (CI)=2.24–10.4)), followed by employer‐sponsored coverage (RRR=2.60, 95% CI=1.67–4.03)).CONCLUSIONS:Prescription drug benefits from VA and state‐sponsored drug programs are strongly associated with use of recommended medications by older adults with DM.