Adherence to treatment with antipsychotic medication and health care costs among medicaid beneficiaries with schizophrenia
Adherence to treatment with antipsychotic medication and health care costs among medicaid beneficiaries with schizophrenia
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DOI：
10.1176/appi.ajp.161.4.692
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发表时间：
2004-04-01
影响因子：
17.7
通讯作者：
Jeste, DV
中科院分区：
文献类型：
--
作者：
Gilmer, TP;Dolder, CR;Jeste, DV
目的：作者的目的是评估抗精神病药物治疗依从性与卫生支出之间的关系。次要目的是确定预测不依从的危险因素。方法：数据包括1998年至2000年加州圣地亚哥县的医疗补助资格和索赔数据。根据累积占有比（可用药物的使用天数除以受试者符合Medi-Cal资格的天数），使用药房记录评估抗精神病药物治疗的依从性。回归模型用于检查与抗精神病药物不依从性、部分依从性、依从性和过量填充相关的风险因素、住院和费用。结果：41%的精神分裂症医疗补助受益人坚持使用抗精神病药物治疗，24%不坚持，16%部分坚持，19%过量服用。黏附者的精神病住院率（14%）低于非黏附者（35%）、部分黏附者（24%）或有多余填充物者（25%）。黏附者的住院率（7%）低于非黏附者（13%）或补牙过多者（12%）。坚持治疗组的住院费用明显低于其他组；黏附者的药房费用高于非黏附者或部分黏附者，并且过量填充物的药房费用最高。过量填充物的总费用（$14,044）大大高于任何其他组的总费用。结论：尽管非典型抗精神病药物的广泛使用，但在精神分裂症的医疗补助受益人中，抗精神病药物处方的使用不足和过度填充的比例都高得惊人。抗精神病药物不依从性的高发生率和相关的负面后果表明需要多层次的干预。
Objective: The authors' goal was to evaluate the relationship between adherence to treatment with antipsychotic medication and health expenditures. A secondary objective was to identify risk factors predictive of nonadherence.Method: Data included Medicaid eligibility and claims data from 1998 to 2000 for San Diego County, Calif. Pharmacy records were used to assess adherence to treatment with antipsychotic medication according to the cumulative possession ratio (the number of days medications were available for consumption divided by the number of days subjects were eligible for Medi-Cal). Regression models were used to examine risk factors, hospitalizations, and costs associated with nonadherence, partial adherence, adherence, and excess fills of antipsychotic medication.Results: Forty-one percent of Medicaid beneficiaries with schizophrenia were found to be adherent to treatment with their antipsychotic medications: 24% were nonadherent, 16% were partially adherent, and 19% were excess fillers. Rates of psychiatric hospitalization were lower for those who were adherent (14%) than for those who were nonadherent (35%), partially adherent (24%), or had excess fills (25%). Rates of medical hospitalization were lower for those who were adherent (7%) than for those who were nonadherent (13%) or had excess fills (12%). Those who were adherent had significantly lower hospital costs than the other groups; pharmacy costs were higher among those who were adherent than among those who were nonadherent or partially adherent and were highest for excess fillers. Total costs for excess fillers ($14,044) were substantially higher than total costs for any other group.Conclusions: Despite the widespread use of atypical antipsychotic medications, alarmingly high rates of both underuse and excessive filling of antipsychotic prescriptions were found in Medicaid beneficiaries with schizophrenia. The high rates of antipsychotic nonadherence and associated negative consequences suggest interventions on multiple levels.