Determinants of adherence to diabetes medications: findings from a large pharmacy claims database.
Determinants of adherence to diabetes medications: findings from a large pharmacy claims database.
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DOI：
10.2337/dc14-2098
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发表时间：
2015-04
期刊：
影响因子：
16.2
通讯作者：
Aubert RE
中科院分区：
文献类型：
--
作者：
Kirkman MS;Rowan-Martin MT;Levin R;Fonseca VA;Schmittdiel JA;Herman WH;Aubert RE
患有糖尿病的成年人通常会服用多种药物来治疗高血糖、糖尿病相关疾病和其他合并症。坚持用药与改善结果有关，包括降低医疗费用、住院和死亡率。我们对一个大型药房索赔数据库进行了回溯性分析，以检查患者、药物和处方者与坚持服用抗糖尿病药物有关的因素。我们提取了在2010年下半年接受非胰岛素药物治疗的20万名糖尿病患者的数据，这些患者到2011年都有资格享受持续的处方药福利。依从性定义为药物持有率≥为0.8%。我们使用了一种修改后的依从性衡量标准，以说明转换治疗的原因。采用Logistic回归分析确定与依从性独立相关的因素。69%的患者是依从者。依从性与年龄较大、男性、受教育程度高、收入较高、使用邮购而不是零售药店、初级保健与非内分泌专家处方医生、较高的每日总药片负担以及较低的自付成本独立相关。新接触糖尿病治疗的患者明显不太可能坚持治疗。几个人口统计学、临床和潜在的可改变的系统水平因素与抗糖尿病药物的坚持有关。通常被认为是健康的患者(那些较年轻、新接触糖尿病且很少服用其他药物的患者)可能面临不坚持治疗的风险。对于所有患者来说，努力减少自付费用并鼓励使用邮购药店可能会导致更高的依从性。
Adults with diabetes typically take multiple medications for hyperglycemia, diabetes-associated conditions, and other comorbidities. Medication adherence is associated with improved outcomes, including reduced health care costs, hospitalization, and mortality. We conducted a retrospective analysis of a large pharmacy claims database to examine patient, medication, and prescriber factors associated with adherence to antidiabetic medications. We extracted data on a cohort of >200,000 patients who were treated for diabetes with noninsulin medications in the second half of 2010 and had continuous prescription benefits eligibility through 2011. Adherence was defined as a medication possession ratio ≥0.8. We used a modified adherence measure that accounted for switching therapies. Logistic regression analysis was performed to determine factors independently associated with adherence. Sixty-nine percent of patients were adherent. Adherence was independently associated with older age, male sex, higher education, higher income, use of mail order versus retail pharmacies, primary care versus nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs. Patients who were new to diabetes therapy were significantly less likely to be adherent. Several demographic, clinical, and potentially modifiable system-level factors were associated with adherence to antidiabetic medications. Patients typically perceived to be healthy (those who are younger, new to diabetes, and on few other medications) may be at risk for nonadherence. For all patients, efforts to reduce out-of-pocket costs and encourage use of mail order pharmacies may result in higher adherence.
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影响因子：
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通讯作者：
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