Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus.
Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus.
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DOI：
10.1002/acr.22636
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发表时间：
2015-12
影响因子：
4.7
通讯作者：
Costenbader KH
中科院分区：
文献类型：
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作者：
Feldman CH;Yazdany J;Guan H;Solomon DH;Costenbader KH
我们研究了在患有系统性红斑狼疮（SLE）的医疗补助受益人中，不依从羟氯喹（HCQ）或免疫抑制药物（IS）是否与随后较高的急性护理利用率相关。我们利用2000-2006年的美国医疗补助数据来识别18-64岁的SLE成人，他们是HCQ或IS的新用户。我们将索引日期定义为在前六个月内未使用的HCQ或IS的接收日期。我们使用药物拥有率（MPR）来衡量依从性，MPR是指索引日期后一年内分配的总供应天数所占的比例。我们的结果是全因和SLE相关的急诊科（艾德）访问和住院在随后的一年。我们使用多变量Poisson回归模型来检验不依从性（MPR<80%）与调整社会人口统计学和合并症后的急性护理利用之间的相关性。我们确定了9,600名HCQ新用户和3,829名IS新用户患有SLE。HCQ的平均MPR为47.8%（SD 30.3），IS为42.7%（SD 30.7）。79%的HCQ使用者和83%的IS使用者未依从（MPR<80%）。在多变量模型中，HCQ使用者中，艾德就诊的发病率比（IRR）为1.55（95% CI 1.43-1.69），住院的IRR为1.37（95% CI 1.25-1.50），比较了非依从者和依从者。对于IS使用者，非依从者与依从者的艾德访视IRR为1.64（95% CI 1.42-1.89），住院IRR为1.67（95% CI 1.41-1.96）。在这个队列中，不遵守HCQ和IS是常见的，并与显着较高的后续急性护理利用。
We examined whether nonadherence to hydroxychloroquine (HCQ) or immunosuppressive medications (IS) was associated with higher subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus (SLE). We utilized U.S. Medicaid data from 2000–2006 to identify adults 18–64 years with SLE who were new users of HCQ or IS. We defined the index date as receipt of HCQ or IS without use in the prior six months. We measured adherence using the medication possession ratio (MPR), the proportion of days covered by total days supply dispensed, for one-year post-index date. Our outcomes were all-cause and SLE-related emergency department (ED) visits and hospitalizations in the subsequent year. We used multivariable Poisson regression models to examine the association between nonadherence (MPR<80%) and acute care utilization adjusting for sociodemographics and comorbidities. We identified 9,600 HCQ new users and 3,829 IS new users with SLE. The mean MPR for HCQ was 47.8% (SD 30.3) and for IS, 42.7% (SD 30.7). 79% of HCQ users and 83% of IS users were nonadherent (MPR<80%). In multivariable models, among HCQ users, the incidence rate ratio (IRR) of ED visits was 1.55 (95% CI 1.43–1.69) and the IRR of hospitalizations was 1.37 (95% CI 1.25–1.50), comparing nonadherers to adherers. For IS users, the IRR of ED visits was 1.64 (95% CI 1.42–1.89) and of hospitalizations was 1.67 (95% CI 1.41–1.96) for nonadherers versus adherers. In this cohort, nonadherence to HCQ and IS was common and was associated with significantly higher subsequent acute care utilization.