Relationship Between Oral Antihyperglycemic Medication Adherence and Hospitalization, Mortality, and Healthcare Costs in Adult Ambulatory Care Patients With Type 2 Diabetes in South Korea
Relationship Between Oral Antihyperglycemic Medication Adherence and Hospitalization, Mortality, and Healthcare Costs in Adult Ambulatory Care Patients With Type 2 Diabetes in South Korea
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DOI：
10.1097/mlr.0b013e31820292d1
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发表时间：
2011-04-01
期刊：
影响因子：
3
通讯作者：
Kang, Hee Chung
中科院分区：
文献类型：
--
作者：
Hong, Jae Seok;Kang, Hee Chung
背景资料：药物依从性已被确定为影响2型糖尿病患者健康结局的主要因素。目的：我们评估初始口服降糖药物依从性与随后健康结局之间的关系。研究设计和受试者：这是一项回顾性队列研究，纳入了40,082名参加韩国国家健康保险计划的患者，年龄在20岁或以上，于2004年首次被诊断出患有2型糖尿病。使用索赔数据对患者进行了3年的随访，以衡量诊断后最初2年口服降糖药物的依从性，并在随访的第三年调查住院率、死亡率和医疗费用。在调整混杂因素后，在处方后的前2年内不依从增加了第3年住院的风险，[比值比（OR）= 1.26，95%可信区间= 1.08-1.47]。与两年中的依从性相比，两年中至少有一年的不依从性增加了住院风险。此外，在第一年和第二年的不依从性与统计学上显著高于依从性的死亡风险相关（比值比= 1.40，95%置信区间= 1.01-1.95）。结论：由于提高糖尿病患者的服药依从性可以为糖尿病患者带来更好的健康结果，并节省国家医疗资源，因此迫切需要政府支持的医疗政策来提高新诊断糖尿病患者的服药依从性。
Background: Medication adherence has been identified as a major factor influencing health outcomes in patients with type 2 diabetes.Objectives: We assessed the relationship between initial adherence to oral antihyperglycemic medications and subsequent health outcomes.Research Design and Subjects: This was a retrospective cohort study of 40,082 patients enrolled in Korea's national health insurance program, who were 20 years of age or older and first diagnosed with type 2 diabetes in 2004. The patients were followed up for 3 years using claims data to measure adherence to oral antihyperglycemic medications for the initial 2 years after diagnosis and to investigate hospitalization, mortality, and healthcare costs in the third year of follow-up.Results: After adjusting for confounders, nonadherence in the first 2 years after prescription increased the risk for hospitalization in the third year compared with adherence over the same period [odds ratio (OR) = 1.26, 95% confidence interval = 1.08-1.47]. Nonadherence in at least one of the 2 years increased the risk for hospitalization compared with adherence in both years. In addition, nonadherence during both the first and second years was associated with statistically significantly greater risks for mortality during this period than was adherence (odds ratio = 1.40, 95% confidence interval = 1.01-1.95). Medication adherence decreased healthcare costs compared with nonadherence (beta = -0.127; P < 0.001).Conclusions: Because improved medication adherence can produce better health outcomes for diabetes patients and also save national healthcare resources, government-sponsored healthcare policies to improve medication adherence among newly diagnosed diabetes patients are urgently required.