Adherence to Newly Prescribed Diabetes Medications Among Insured Latino and White Patients With Diabetes
Adherence to Newly Prescribed Diabetes Medications Among Insured Latino and White Patients With Diabetes
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DOI：
10.1001/jamainternmed.2016.8653
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发表时间：
2017-03-01
影响因子：
39
通讯作者：
Karter, Andrew J.
中科院分区：
文献类型：
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作者：
Fernandez, Alicia;Quan, Judy;Karter, Andrew J.
重要性 坚持用药对于糖尿病护理至关重要。患者与医生的语言障碍可能会影响拉丁美洲人的药物依从性。目的确定患者种族/族裔、首选语言和医生语言一致性与患者对新开的糖尿病药物的依从性之间的关系。设计、设置和参与者这项观察性研究是从 2006 年 1 月 1 日到 2012 年 12 月 31 日在一个配备专业口译服务的大型综合医疗保健服务系统中进行的。受保 2 型糖尿病患者，包括新开糖尿病药物的说英语的白人、说英语的拉丁裔或英语水平有限 (LEP) 的拉丁裔患者。 暴露 患者种族/民族、首选语言和医生自我报告的西班牙语流利程度。 主要结果和措施 原发性不依从性（从未配药）、早期不坚持（仅配药一次）、晚期不持久（已接受 >= 2 次配药，但在 24 个月内停药），以及总体药物依从性不足（初次处方后 24 个月内没有足够药物供应的时间超过 20%）。 结果 参与者包括 21 878 名白人患者、5 755 名讲英语的拉丁裔患者和 3 205 名 LEP 拉丁裔患者，总共开出 46 131 份新糖尿病药物处方。在 LEP 拉丁裔患者中，50.2%（n = 1610）的初级保健医生报告西班牙语流利程度很高。对于口服药物，早期依从性差异很大：1032 名 LEP 拉丁裔患者 (32.2%)、1565 名讲英语的拉丁裔患者 (27.2%) 和 4004 名白人患者 (18.3%) 要么是原发性不依从，要么是早期不坚持。在 1929 名 LEP 拉丁裔患者 (60.2%)、2975 名讲英语的拉丁裔患者 (51.7%) 和 8204 名白人患者 (37.5%) 中观察到整体依从性不足。对于胰岛素，早期不坚持治疗的比例在 LEP 拉丁裔患者 (n = 1372) 中为 42.8%，在说英语的拉丁裔患者中为 34.4% (n = 1980)，在白人患者中为 28.5% (n = 6235)。调整患者和医生特征后，LEP 拉丁裔患者比说英语的拉丁裔患者更有可能不坚持口服药物和胰岛素（相对风险从 1.11 [95% CI, 1.06-1.15] 到 1.17 [95% CI, 1.02-1.34]；P
IMPORTANCE Medication adherence is essential to diabetes care. Patient-physician language barriers may affect medication adherence among Latino individuals.OBJECTIVE To determine the association of patient race/ethnicity, preferred language, and physician language concordance with patient adherence to newly prescribed diabetes medications.DESIGN, SETTING, AND PARTICIPANTS This observational study was conducted from January 1, 2006, to December 31, 2012, at a large integrated health care delivery system with professional interpreter services. Insured patients with type 2 diabetes, including English-speaking white, English-speaking Latino, or limited English proficiency (LEP) Latino patients with newly prescribed diabetes medication.EXPOSURES Patient race/ethnicity, preferred language, and physician self-reported Spanish-language fluency.MAIN OUTCOMES AND MEASURES Primary nonadherence (never dispensed), early-stage nonpersistence (dispensed only once), late-stage nonpersistence (received >= 2 dispensings, but discontinued within 24 months), and inadequate overall medication adherence (>20% time without sufficient medication supply during 24 months after initial prescription).RESULTS Participants included 21 878 white patients, 5755 English-speaking Latino patients, and 3205 LEP Latino patients with a total of 46 131 prescriptions for new diabetes medications. Among LEP Latino patients, 50.2%(n = 1610) had a primary care physician reporting high Spanish fluency. For oral medications, early adherence varied substantially: 1032 LEP Latino patients (32.2%), 1565 English-speaking Latino patients (27.2%), and 4004 white patients (18.3%) were either primary nonadherent or early nonpersistent. Inadequate overall adherence was observed in 1929 LEP Latino patients (60.2%), 2975 English-speaking Latino patients (51.7%), and 8204 white patients (37.5%). For insulin, early-stage nonpersistence was 42.8% among LEP Latino patients (n = 1372), 34.4% among English-speaking Latino patients (n = 1980), and 28.5% among white patients (n = 6235). After adjustment for patient and physician characteristics, LEP Latino patients were more likely to be nonadherent to oral medications and insulin than English-speaking Latino patients (relative risks from 1.11 [95% CI, 1.06-1.15] to 1.17 [95% CI, 1.02-1.34]; P