Pharmacy Accessibility and Disparities in Adherence to Cardiovascular Medications in Elderly

描述(由申请人提供)：我们建议使用现有的专有和公共数据源和地理空间方法来确定药店的地理可达性如何影响美国老年人在遵守心血管药物方面的地区差异。考虑到心血管药物的健康和生存益处，这个问题处于老年少数群体健康和健康政策的前沿，而且最近扩大的老年人处方药覆盖范围未能减少遵守处方药方面的差异。此外，几项国家研究表明，遵从性方面的差异并不是由于收入、教育或医疗保险方面的个人差异，并表明老年少数群体在遵守白人同行没有经历过的处方药方面可能会遇到障碍，包括药店的可及性。我们的初步分析表明，在药房密度和对他汀类药物和�储物柜的依从性方面，存在显著的地点差异。在拟议的研究中，我们将利用美国5000多万美国人的地理编码纵向患者级别药房索赔数据和药房位置信息进行观察性队列研究，以检查药店的地理可达性或药房密度如何影响美国65岁及以上成年人遵守常用心血管药物(包括他汀类药物和阻滞剂)的差异。我们还将检查个人因素(如年龄、多药)和社区水平(如贫困、车辆拥有)因素通常与遵从性相关的作用。最后，我们将应用地理空间方法，使用在社区一级聚集的患者级别的依从性来识别最有可能出现低依从性的老年少数群体社区。我们提议的工作是创新的，因为这将是第一个将地理空间方法纳入分析老年人服药依从性差异的研究。我们的数据还将使我们能够以前所未有的粒度检查影响国家和地方一级遵守情况差异的个人和社区层面的因素。考虑到药店是美国老年人口医疗保健服务的一个日益重要但往往被忽视的组成部分，我们对药店地理可及性的作用的关注是新颖的。关于预期结果，拟议的工作预计将贡献新的知识，政策制定者、从业者和研究人员需要这些知识来制定创新的政策和计划，以改善老年人服药依从性的差异。这一点尤其重要，因为越来越多的少数族裔人口有公共保险，而且医疗保险/医疗补助服务中心已经批准了质量措施，其中包括坚持服用尚未在差异背景下审查的心血管药物。这些结果预计将产生积极影响，因为随着药房的服务范围继续扩大，包括预防性护理，它们的重要性和与健康差距的相关性只会越来越大。

DESCRIPTION (provided by applicant): We propose to use existing proprietary and public data sources and geospatial methods to determine how the geographic accessibility of pharmacies impacts place-based disparities in adherence to cardiovascular medications among older adults in the U.S. This issue is at the forefront of older adult minority health and health policy, considering the health and survival benefits of cardiovascular medications and recent expansion of older adult prescription drug coverage has failed to reduce disparities in adherence to prescription medications. Further, several national studies indicate that disparities in adherence are not due to individual differences in income, education or health insurance, and suggest older adult minorities may encounter barriers in adhering to prescription medications not experienced by their White counterparts, including the accessibility of pharmacies. Our preliminary analyses suggest substantial place-based disparities in both pharmacy density and adherence to both statins and �locker. For the proposed study, we will leverage geocoded longitudinal patient-level pharmacy claims data for more 50 million Americans, and information on pharmacy locations, in the United States to conduct an observational cohort study to examine how the geographic accessibility of pharmacies or pharmacy density impacts disparities in adherence to commonly used cardiovascular medications, including statins and blockers, among adults 65 years and older in the U.S. We will also examine the role of individual- (e.g. age, poly-pharmacy) and community-level (e.g. poverty, vehicle ownership) factors often associated with adherence. Finally, we will apply geospatial methods using patient-level adherence aggregated at the community-level to identify older adult minority communities most at-risk for low-adherence. Our proposed work is innovative because it will be the first study to incorporate geospatial methods in analyses of disparities in medication adherence at older ages. Our data will also allow for unprecedented granularity in examining individual and community-level factors that influence disparities in adherence at national and local levels. Our focus on the role of the geographic accessibility of pharmacies is novel considering pharmacies are an increasingly important, yet often overlooked, component of U.S. health care delivery in the older adult population. With respect to expected outcomes, the work proposed is expected to contribute new knowledge which policymakers, practitioners and researchers need to develop innovative policies and programs to improve disparities in medication adherence among older adults. This is particularly important given a growing segment of the minority population is publicly insured and Centers for Medicare/Medicaid Services has endorsed quality measures that include adherence to cardiovascular medications that have yet to be examined in the context of disparities. These outcomes are expected to have a positive impact, as pharmacies will only grow in importance and relevance to health disparities as their scope of services continues to expand to include preventative care.