Adherence to Inhaled Medications and its Effect on Healthcare Utilization and Costs Among High-Grade Chronic Obstructive Pulmonary Disease Patients
Adherence to Inhaled Medications and its Effect on Healthcare Utilization and Costs Among High-Grade Chronic Obstructive Pulmonary Disease Patients
复制标题
DOI：
10.1007/s40261-017-0612-2
复制
发表时间：
2018-04-01
影响因子：
3.2
通讯作者：
Rhee, Chin Kook
中科院分区：
文献类型：
--
作者：
Kim, Jee-Ae;Lim, Min Kyoung;Rhee, Chin Kook
背景：吸入药物治疗方案的依从性影响慢性阻塞性肺疾病（COPD）的预后和生活质量，并减少医疗服务的使用，目的研究高血压患者坚持吸入药物治疗方案对医疗保健利用和费用的影响，方法我们使用韩国健康保险回顾的纵向数据集进行了一项观察性回顾性队列研究，评估服务（2008-2013年），包含5 000万受益人的保健服务信息。研究人群为重度COPD患者。“依从性”定义为达到药物拥有率（MPR）>= 80%的患者。我们使用多变量逻辑回归估计了依从性对重症监护室（ICU）和急诊室（ER）使用的影响，并估计了对成本的影响（全因和COPD相关）使用广义线性模型，调整患者的社会人口学特征、健康状况和合并症。依从性在4年内从34.7%下降到22.3%。依从性与ICU的使用和费用呈负相关，并且随着依从性时间的延长，这种关联变得更强。在4年期间，依从组使用ICU的可能性低于非依从组[比值比（OR）= 0.74，95%置信区间（CI）0.60-0.91]。同样，遵守组有一个低10.4%的全因成本（p < 0.001）和一个低11.7%的COPD相关成本（p < 0.0001）vs. non-adherence group.Conclusions遵守降低医疗保健利用率和成本，所以遵守不仅是临床有效的，但也经济有效。然而，不到四分之一的人口仍然坚持超过4年的时间，这表明需要采取战略，以提高依从性。
Background Adherence to inhaled medication regimens affects chronic obstructive pulmonary disease (COPD) prognosis and quality of life, and reduces the use of healthcare services, resulting in cost savings.Objectives To examine the effects of adherence to inhaled medication regimens on healthcare utilization and costs in high-grade COPD patients.Methods We performed an observational retrospective cohort study using a longitudinal data set from the Korean Health Insurance Review and Assessment Service (2008-2013) containing healthcare services' information for 50 million beneficiaries. The study population was high-grade COPD patients. "Adherent" was defined as a patient attaining a medication possession ratio (MPR) >= 80%. We estimated the effects of adherence on the use of intensive care units (ICUs) and emergency rooms (ERs) using a multivariate logistic regression, and estimated the effects on costs (all-cause and COPD-related) using a generalized linear model, with adjustment for patient sociodemographic characteristics, health status, and comorbidities.Results Of 9086 high-grade COPD patients, adherence declined from 34.7 to 22.3% over 4 years. Adherence was inversely associated with use of ICUs and costs, and this association got stronger as the adherence period lengthened. Over the 4-year period, the adherent group had a lower likelihood of using ICUs [odds ratio (OR) = 0.74, 95% confidence interval (CI) 0.60-0.91] than the non-adherent group. Similarly, the adherent group had a 10.4% lower all-cause cost (p < 0.001) and an 11.7% lower COPD-related cost (p < 0.0001) versus the non-adherent group.Conclusions Adherence reduces healthcare utilization and costs, so adherence is not only clinically effective but also economically efficient. However, less than one-quarter of this population remained adherent over the 4-year period, suggesting that strategies are needed to improve adherence.