Prescriber continuity and medication availability in older adults with cardiometabolic conditions
Prescriber continuity and medication availability in older adults with cardiometabolic conditions
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DOI：
10.1177/2050312118757388
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发表时间：
2018-02-06
影响因子：
2.3
通讯作者：
Wang, Virginia
中科院分区：
文献类型：
--
作者：
Maciejewski, Matthew L.;Hammill, Bradley G.;Wang, Virginia
背景：许多老年人患有多种疾病，并看到多个提供者，这可能会影响他们对基本药物的使用。目的：我们调查了这些药物的处方数量是否与可获得的药物有关，这些药物是治疗糖尿病、高血压或血脂异常的替代药物。方法：对居住在美国10个州的383,145名患有糖尿病、高血压或血脂异常的老年患者进行回顾性队列调查。通过Logistic回归，控制患者的人口学特征和慢性疾病，估计2010年的心脏代谢药物处方人数和2011年的药物可获得性(手头有药的天数比例)之间的关系。结果：患有糖尿病、高血压和/或血脂异常的医疗保险受益人平均总共有5种慢性病，获得了10-12种所有疾病的药物，最常见的情况是有一名心脏代谢药物的处方者。在调整后的分析中，处方医生的数量与口服糖尿病药物的可获得性没有显著相关性，但在患有血脂异常或高血压的老年医疗保险受益人中，处方医生的数量与药物可获得性的增加相关。结论：对于复杂的患者，增加新的处方医生在临床上可能是合理的，但随着时间的推移，可能会造成协调问题和信息中断。卫生系统可能希望识别拥有多个处方的复杂患者，以最大限度地减少护理碎片化。
Background: Many older adults have multiple conditions and see multiple providers, which may impact their use of essential medications.Objective: We examined whether the number of prescribers of these medications was associated with the availability of medications, a surrogate for adherence, to manage diabetes, hypertension or dyslipidemia.Methods: A retrospective cohort of 383,145 older adults with diabetes, hypertension or dyslipidemia in the US Medicare program living in 10 states. The association between the number of prescribers of cardiometabolic medications in 2010 and medication availability (proportion of days with medication on hand) in 2011 was estimated via logistic regression, controlling for patient demographic characteristics and chronic conditions.Results: Medicare beneficiaries with diabetes, hypertension and/or dyslipidemia had an average of five chronic conditions overall, obtained 10-12 medications for all conditions and most often had one prescriber of cardiometabolic medications. In adjusted analyses, the number of prescribers was not significantly associated with availability of oral diabetes agents but having more prescribers is associated with increased medication availability in older Medicare beneficiaries with dyslipidemia or hypertension.Conclusion: The incremental addition of new prescribers may be clinically reasonable for complex patients but creates the potential for coordination problems and informational discontinuity over time. Health systems may want to identify complex patients with multiple prescribers to minimize care fragmentation.