Developing an Integrated Longitudinal Dataset for Patient-Centered Outcome Measures in Cost-Related Medication Nonadherence.
Developing an Integrated Longitudinal Dataset for Patient-Centered Outcome Measures in Cost-Related Medication Nonadherence.
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DOI：
10.1097/mlr.0000000000001894
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发表时间：
2023-12-01
期刊：
影响因子：
3
通讯作者：
Meltzer, David O.
中科院分区：
文献类型：
--
作者：
Zhang, James X.;Meltzer, David O.
与费用相关的药物不依从性（CRN）是一项重要的以患者为中心的结果衡量指标。对CRN的纵向随访很罕见。
我们提议开发一个新的综合数据集来纵向研究CRN。
一个包含2000名有高住院风险的医疗保险受益人数据集，这些人在2013年至2018年期间每季度接受关于CRN的调查，并单独随访8个季度，该数据集与医疗保险档案相关联。开发了一种在8个季度期间对持续性、间歇性和短暂性CRN进行分类的CRN指标。分别建立了有序逻辑模型和逻辑模型来评估影响总体CRN和持续性CRN的因素。
共有1761名患者被纳入分析，其中869人（49.3%）在8个季度的研究期间至少报告过一次CRN，178人（10%）报告了持续性CRN，395人（22.4%）报告了间歇性CRN，296人（16.8%）报告了短暂性CRN。持续性CRN的逻辑模型中的条件效应显示，基线双重符合资格与持续性CRN呈负相关（调整后的优势比 = 0.45，P < 0.01），抑郁症与持续性CRN呈正相关（调整后的优势比 = 1.55，P = 0.01）。有序逻辑模型中的边际分析显示出一种明显的模式，即较年轻年龄组出现持续性和间歇性CRN的概率较高，而短暂性CRN则较为平稳。在252名死亡的受试者中，31人（12.3%）报告了持续性CRN，而在存活的受试者中这一比例为147人（9.74%）（通过卡方检验，P = 0.21）。
大量患者报告了持续性CRN，包括那些处于生命末期的患者。迫切需要进行研究以了解较年轻的医疗保险人群的行为模式。
Cost-related medication nonadherence (CRN) is an important patient-centered outcome measure. Longitudinal follow-up of CRN is rare. We propose to develop a novel integrated dataset to study CRN longitudinally. A dataset of 2000 Medicare beneficiaries at high risk of hospitalization surveyed quarterly on CRN and followed up individually for 8 quarters between 2013 and 2018 was linked to Medicare files. A metric of CRN categorizing persistent, intermittent, and transient CRN during the 8 quarters was developed. An ordered logit model and a logit model were developed to assess the factors influencing CRN overall and persistent CRN, respectively. A total of 1761 patients were included in the analysis, among whom 869 (49.3%) reported CRN at least once in the 8-quarter study period, 178 (10%) reported persistent CRN, 395 (22.4%) reported intermittent CRN, and 296 (16.8%) reported transient CRN. The conditional effect in the logit model for persistent CRN revealed that baseline dual eligibility was negatively associated (adjusted odds ratio = 0.45, P < 0.01) and depression positively associated (adjusted odds ratio = 1.55, P = 0.01) with persistent CRN. The marginal analysis in the ordered logit model revealed a clear pattern of higher probabilities of persistent and intermittent CRN at younger ages while transient CRN was flat. Among the 252 subjects who were deceased, 31 (12.3%) reported persistent CRN, compared with 147 (9.74%) who were alive (P = 0.21 by χ2 test). A significant number of patients reported persistent CRN, including those who were at the end of life. Research is critically needed to understand behavioral patterns among the younger Medicare population.