Medication Oversupply and Outcomes in Patients with Diabetes

摘要：糖尿病的有效治疗通常需要患者遵循复杂的、多种药物治疗方案来控制血糖、血压和血脂。然而，这些方案对患者来说很难遵循，并且会增加药物不良事件的风险，特别是对于老年人或患有其他严重合并症的患者。虽然糖尿病患者获得的药物少于处方（即药物供应不足）的危险是众所周知的，但获得药物供应过剩的风险——超过维持依从性所需药物的120%——却远远没有得到重视。如果手头有大量不需要的药物会导致患者过度使用或滥用药物，那么可能会导致负面后果。在“封闭”的卫生系统中进行的一些研究发现，供应商和药房通过单一的电子健康记录（EHR）联系在一起，发现用于糖尿病的药物供应过剩是昂贵和常见的，发生在高达50%的患者身上，但在典型的美国实践中，糖尿病患者供应过剩的程度和风险因素尚不清楚。供过于求对糖尿病患者的安全风险程度也是未知的，特别是那些临床复杂性更大的患者，他们可能难以管理和耐受处方药。本研究拟通过以下方式解决这些关键问题：1)描述糖尿病患者口服降糖药、降压药和血脂异常药物供应过剩的患病率和风险概况；2)检查供应过剩对全因和可能与药物相关的短期负面结果（住院、急诊科使用或死亡）的影响，以及这些影响对复杂程度较高的患者是否更大。我们的样本包括大约2440名糖尿病患者，这些患者在2006-2008年期间接受了中西部一个大型多专科医生小组的治疗。我们的方法利用一种独特的数据资源，将电子健康记录数据链接到来自医疗保险和大型本地健康维护组织（HMO）的管理数据。我们将使用滞后逻辑回归来估计供过于求对负面结果的影响，并结合倾向得分来调整几个潜在的混淆源。本研究将有助于明确糖尿病药物供应过剩的范围、原因和后果，并为加强药物管理干预和减少糖尿病患者药物不良事件奠定基础。

DESCRIPTION (provided by applicant): Medication Oversupply and Outcomes in Patients with Diabetes Abstract Effective management of diabetes often requires patients to follow complex, multiple-drug regimens to control blood glucose, blood pressure, and lipids. However, these regimens are difficult for patients to follow and come with increased risk of adverse drug events, particularly for older adults or those with other serious co- morbidities. Although the dangers of diabetes patients' obtaining less medication than prescribed (i.e. medication undersupply) are well-recognized, the risks of obtaining oversupply of medications - greater than 120% of the medication required for maintaining adherence - have been far less appreciated. If having large quantities of unneeded medication on hand promotes patients' overuse or misuse of medications, then negative outcomes may result. A few studies conducted in "closed" health systems in which providers and pharmacies are connected through a single electronic health record (EHR) have found oversupply of medications used in diabetes to be costly and common, occurring in up to 50% of patients, but the magnitude and risk factors of oversupply for diabetes patients in a typical U.S. practice is unknown. It is also unknown the extent to which oversupply may pose a safety risk to patients with diabetes, particularly those with greater clinical complexity who may have difficulty managing and tolerating prescribed medications. The proposed research addresses these critical questions by 1) describing the prevalence and risk profile of oversupply of oral hypoglycemic, antihypertensive, and dyslipidemic medications in diabetes patients, and 2) examining the effect of oversupply on all-cause and possible drug-related short-term negative outcomes (hospitalization, emergency department use, or death) and whether these effects are greater for more versus less complex patients. Our sample includes approximately 2,440 patients with diabetes who were cared for by a large Midwestern multi-specialty physician group during 2006-2008. Our approach utilizes a unique data resource linking electronic health record data to administrative data from Medicare and a large local health maintenance organization (HMO). We will estimate effects of oversupply on negative outcomes using lagged logistic regression incorporating propensity scores to adjust for several potential sources of confounding. This study will help define the scope, causes, and consequences of medication oversupply in diabetes and lay the groundwork for enhancing medication management interventions and reducing adverse drug events in diabetes patients. PUBLIC HEALTH RELEVANCE: We propose to examine the predictors and consequences of medication oversupply - acquiring more medication than is needed to maintain adherence - for adult patients with diabetes. Oversupply of diabetes medications may lead patients to make errors in following their treatment regimen and result in negative outcomes, but the health risks to patients remain undefined. The results from our investigation will define the scope of an under-recognized patient safety risk in diabetes and inform the design of efforts to improve medication management and reduce adverse drug events in this common, costly, and difficult to manage illness.