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？

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要/摘要药物的金融燃烧是药物依从性和随后的糖尿病的重大障碍控制。利益设计减少了被认为更具成本效益的服务的共付额（称为 “基于价值的保险设计”或VBIDS）继续吸引公共和私人保护的注意力，雇主和政策制定者是提高依从性并降低长期成本的战略。而vbid 减少慢性疾病药物共生的计划已被证明是正短的期限对药物依从性的影响，我们对临床增长的长期可持续性的了解不多，随着时间的流逝特别是当消除激励措施时。此外，几乎了解哪些因素会影响谁参与和当健康计划在现实世界中的多雇主设置中引入VBID计划时，谁受益。这研究将评估一个名为WellRX Drug的现实世界VBID计划的提供和中断骑手 - 零COPAY毒品福利提供了更有效地吸引患者的自我保健。为了利用这个独特的自然实验，我们将使用包括患者在内的多方法方法邮寄调查，患者和雇主的半结构化访谈以及准实验纵向研究使用前post与比较组和患者级中断时间序列与比较系列以评估WellRX在糖尿病患者中的影响。这项研究是由四个具体目标：（1）检查确定有关员工之间的wellrx参与的决定糖尿病患者和高危患者亚组的评估差异（例如种族和社会经济地位）; （2）检查自我管理，利用和成本以及临床结果的变化（HBA1C，脂质，血压控制）在1年的基准和最多4年的随访中，比较患者与雇员没有的承诺匹配的患者相比，雇主提供了免费计划；（3）到在计划中止后评估结果的可持续性，比较其员工的患者继续或选择在后续几年中停止wellrx覆盖范围；（4）确定是否在目标2和3中观察到的变化因种族/种族，收入，教育程度或基线而不同不遵守。拟议的研究解决了现实世界中的务实问题，该问题具有很高的动力改善糖尿病患者多样性人群的护理，自我效能和结果的机会。我们的调查结果将为未来的努力提供创建福利设计的努力，这些设计符合提供者的效果，符合患者需求，解决患者参与度的障碍，并提高患者维持有效糖尿病控制的能力。