Ethnic disparities in adherence to antihypertensive medications of medicare part D beneficiaries.
Ethnic disparities in adherence to antihypertensive medications of medicare part D beneficiaries.
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DOI：
10.1111/j.1532-5415.2012.04037.x
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发表时间：
2012-07
影响因子：
6.3
通讯作者：
Goodwin JS
中科院分区：
文献类型：
--
作者：
Holmes HM;Luo R;Hanlon JT;Elting LS;Suarez-Almazor M;Goodwin JS
不依从抗高血压药物是常见的，并导致不良的健康结果。医疗保险D部分处方药计划降低了成本，增加了获得药物的机会，从而可能提高药物依从性。确定与较高的抗高血压药物依从性水平相关的D部分受益人的依从性水平和特征。使用2007年医疗保险索赔和D部分事件文件进行回顾性分析。医疗保险D部分登记者患有普遍的无并发症的高血压，他们在2006年至少填写了一张抗高血压处方，在2007年填写了两张处方。药物依从性定义为平均药物持有率（MPR）≥ 80%。评价的与依从性相关的潜在因素包括年龄、性别、种族/民族、社会经济因素、合并症、药物使用、共同负担费用、处于覆盖范围缺口和独特处方者的数量。在2007年接受抗高血压药物治疗的168，522名普遍无并发症高血压的医疗保险D部分登记者中，总体依从性为79.5%。在单变量分析中，大多数患者因素的依从性差异显着。在多变量分析中，与白人相比，黑人（OR 0.53，95% CI 0.51-0.55）、西班牙裔（OR 0.58，95% CI 0.55-0.61）和其他非白人种族（OR 0.80，95% CI 0.75-0.85）的依从性持续降低。合并症和合并用药的增加也与依从性降低相关。不同地理区域的依从性存在显著差异。我们确定了患者因素与抗高血压药物依从性的相关性，不同种族的依从性存在显著差异。提高依从性可能会对公共卫生产生重大影响，并可能改善高血压的特定结局，以及改善成本和医疗保健利用率。
Nonadherence to antihypertensive medication is common and leads to adverse health outcomes. The Medicare Part D prescription drug program has decreased cost and increased access to medications, thus potentially improving medication adherence. To determine the level of adherence and characteristics of Part D beneficiaries associated with higher levels of antihypertensive medication adherence. Retrospective analysis using Medicare claims and Part D event files for 2007. Medicare Part D enrollees with prevalent uncomplicated hypertension who filled at least one antihypertensive prescription in 2006 and two prescriptions in 2007. Medication adherence was defined by an average Medication Possession Ratio (MPR) of 80% or greater. Potential factors associated with adherence evaluated included age, sex, race/ethnicity, socioeconomic factors, comorbidity, medication use, copay, being in the coverage gap, and number of unique prescribers. Among 168,522 Medicare Part D enrollees with prevalent uncomplicated hypertension receiving antihypertensive medicines in 2007, overall adherence was 79.5%. In univariate analysis, adherence varied significantly by most patient factors. In multivariable analysis, decreased odds of adherence persisted for blacks (OR 0.53, 95% CI 0.51–0.55), Hispanics (OR 0.58, 95% CI 0.55–0.61) and other non-white races (OR 0.80 95% CI 0.75–0.85) compared to whites. Increased comorbidity and concurrent medication use were also associated with reduced adherence. Adherence was significantly different across several geographic regions. We identified a number of associations with patient factors and medication adherence to antihypertensive drugs, with significant differences in adherence by ethnicity. Improving adherence could have significant public health implications and could improve outcomes specific to hypertension as well as improved cost and healthcare utilization.
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