Does Free Medicines Coverage Improve Diabetes Self-Care and Outcomes for Diverse Populations?

免费药物覆盖范围是否可以改善不同人群的糖尿病自我护理和结果？

• 批准号: 9310036
• 负责人: Connie Mah Trinacty
• 金额: $ 77.1万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9310036
• 关键词: Address; Adherence; Adult; Affect; Attention; Behavior; Blood Glucose; Body Weight; Body mass index; Caring; Case Manager; Cessation of life; Charge; Chronic; Chronic Disease; Clinical; Data; Diabetes Mellitus; Disease Management; Education; Emergency department visit; Employee; Enrollment; Ethnic Origin; Evaluation; Failure; Future; Glycosylated hemoglobin A; Hawaii; Health; Health Planning; Health Services Accessibility; Health system; Healthcare; Hospitalization; Improve Access; Incentives; Incidence; Income; Insurance; Insurance Carriers; Interruption; Interview; Light; Link; Lipids; Longitudinal Studies; Low income; Mail Order; Medicine; Methods; Minority; Morbidity - disease rate; Natural experiment; Outcome; Patient Preferences; Patient risk; Patients; Pharmaceutical Preparations; Pharmacy facility; Policy Maker; Population Heterogeneity; Primary Health Care; Privatization; Provider; Quality of Care; Race; Recommendation; Risk; Self Care; Self Care outcome; Self Efficacy; Self Management; Series; Services; Socioeconomic Status; Structure; Subgroup; Surveys; System; Time; Translating; Wellness Program; Work; World Health; base; blood pressure regulation; clinical care; cohort; comparison group; copayment; cost; cost effective; design; diabetes control; diabetes management; disorder control; disparity reduction; ethnic minority population; follow-up; glucose monitor; health service use; high risk; improved; interest; medication compliance; member; mortality; patient population; payment; programs; racial and ethnic; racial and ethnic disparities; racial minority; socioeconomic disparity; socioeconomics; uptake

PROJECT SUMMARY/ABSTRACT The financial burden of medications is a significant barrier to medication adherence and subsequent diabetes control. Benefit designs that reduce copayments for services that are seen to be more cost-effective (known as “value-based insurance designs” or VBIDs) continue to capture the attention of public and private insurers, employers, and policy makers as a strategy to improve adherence and reduce long-term costs. While VBID programs that reduce copayments for chronic illness medications have been shown to have a positive short- term impact on medication adherence, we know less about long-term sustainability of clinical gains over time, particularly when incentives are eliminated. Also, little is known about which factors affect who participates and who benefits when VBID programs are introduced by a health plan in a real-world, multi-employer setting. This study will evaluate the provision and discontinuation of a real-world VBID program called the WellRx Drug Rider -- a zero copay drug benefit offered to engage patients more effectively in their self-care. To take advantage of this unique natural experiment, we will use a multi-method approach including patient- mailed surveys, semi-structured interviews of patients, providers, and employers, and a quasi-experimental longitudinal study using pre-post with comparison group and patient-level interrupted time series with comparison series to evaluate the impact of WellRx among patients with diabetes. This study is motivated by four specific aims: (1) to examine determinants of decisions about WellRx participation among employers and patients with diabetes and assess differences in at-risk patient subgroups (e.g., race and socioeconomic status); (2) to examine changes in self-management, utilization and costs, and clinical outcomes (HbA1c, lipid, blood pressure control) over a 1-year baseline and up to 4-year follow-up, comparing patients whose employers offered the free program compared to propensity-matched patients whose employers did not; (3) to assess sustainability of outcomes following program discontinuation, comparing patients whose employers continue or choose to discontinue WellRx coverage in later follow-up years; and (4) to determine whether the changes observed in Aims 2 and 3 differ by race/ethnicity, income, education attainment, or baseline nonadherence. The proposed study addresses pragmatic questions in a real-world health system that is highly motivated to improve access to care, self-efficacy, and outcomes for a diverse population of patients with diabetes. Our findings will inform future efforts to create benefit designs that are provider-endorsed, align with patient needs, address barriers to patient engagement, and improve patient capacity to maintain effective diabetes control.

项目总结/摘要 药物的经济负担是药物依从性和随后糖尿病的重要障碍 控制福利设计，减少被视为更具成本效益的服务的共同负担（称为 “基于价值的保险设计”或VBID）继续吸引公共和私人保险公司的注意， 雇主和决策者作为一种战略，以提高遵守和减少长期成本。虽然VBID 减少慢性病药物共同负担的计划已被证明具有积极的短期效果， 对药物依从性的长期影响，我们对随着时间的推移临床收益的长期可持续性知之甚少， 特别是当激励措施被取消时。此外，关于哪些因素影响参与者以及 当健康计划在现实世界中引入VBID计划时，谁受益，多雇主设置。这 这项研究将评估一项名为WellRx药物的真实世界VBID计划的提供和中止情况 骑士-零共付药物福利提供更有效地参与病人在他们的自我保健。 为了利用这种独特的自然实验，我们将使用多种方法，包括患者- 邮寄调查，病人，供应商和雇主的半结构化访谈，以及一个准实验性的 纵向研究，使用前后对照组和患者水平的中断时间序列， 比较系列，以评估WellRx在糖尿病患者中的影响。这项研究的动机是 四个具体目标： (1)研究雇主参与WellRx的决定因素， 患有糖尿病的患者并评估处于危险中的患者亚组的差异（例如，种族和社会经济 status）; (2)检查自我管理、利用和成本以及临床结果（HbA 1c，血脂， 血压控制）超过1年的基线和长达4年的随访，比较 雇主提供的免费程序相比，倾向匹配的病人，雇主没有;（3）， 评估项目终止后结果的可持续性，比较雇主 继续或选择在以后的随访年中停止WellRx覆盖;以及（4）确定 目标2和3中观察到的变化因人种/种族、收入、教育程度或基线而异 不依从。 这项拟议的研究解决了现实世界卫生系统中的务实问题，该系统高度积极地 改善不同人群糖尿病患者的护理、自我效能和结局。我们 研究结果将为未来的努力提供信息，以创建提供者认可的福利设计，符合患者需求， 解决患者参与的障碍，提高患者维持有效糖尿病控制的能力。