A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan
A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan
复制标题
DOI：
10.18553/jmcp.2016.22.1.63
复制
发表时间：
2016-01-01
影响因子：
2.1
通讯作者：
Fleming, Marc
中科院分区：
文献类型：
--
作者：
Abughosh, Susan M.;Wang, Xin;Fleming, Marc
背景：合并高血压(HTN)和糖尿病(DM)的患者是发生糖尿病大血管和微血管并发症的高危人群。控制高血压可以极大地减少这些并发症。血管紧张素转换酶抑制剂(ACEI)或血管紧张素II受体阻滞剂(ARB)是美国糖尿病协会指南推荐用于糖尿病和HTN患者的药物，其在减少糖尿病大血管和微血管并发症方面的益处和有效性已得到很好的证明。然而，依从性差仍然是实现完全有效性和最佳结果的一个重要障碍。目的：检查短暂的药剂师电话干预在确定依从性障碍和改善参加Medicare Advantage计划的未依从性HTN和DM患者对ACEI/ARB药物依从性方面的效果。方法：在2013年1月至2013年10月期间，使用Cigna-HealthSpring的医疗索赔数据来识别HTN和DM诊断患者，使用ICD-9-CM代码401和250，并至少填写2个用于ACEI或ARB的信息。超过1天没有补充药物并有一定天数覆盖的患者(PDC)
BACKGROUND: Patients with comorbid hypertension (HTN) and diabetes mellitus (DM) are at a high risk of developing macrovascular and micro vascular complications of DM. Controlling high blood pressure can greatly reduce these complications. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are recommended for patients with both DM and HTN by the American Diabetes Association guidelines, and their benefit and efficacy in reducing macrovascular and microvascular complications of DM have been well documented. Poor adherence, however, remains a significant barrier to achieving full effectiveness and optimal outcomes.OBJECTIVE: To examine the effect of a brief pharmacist telephone intervention in identifying adherence barriers and improving adherence to ACEI/ARB medications among nonadherent patients with comorbid HTN and DM who are enrolled in a Medicare Advantage plan.METHODS: Cigna-HealthSpring's medical claims data was used to identify patients with HTN and DM diagnoses by using ICD-9-CM codes 401 and 250, and at least 2 fills for ACEIs or ARBs between January 2013 and October 2013. Patients who failed to refill their medication for more than 1 day and had a proportion of days covered (PDC)