Medication Oversupply and Outcomes in Patients with Diabetes

描述(申请人提供)：糖尿病患者的药物供应过剩和结果摘要糖尿病的有效管理通常要求患者遵循复杂的多种药物方案来控制血糖、血压和血脂。然而，这些方案对患者来说很难遵循，并且伴随着不良药物事件的风险增加，特别是对于老年人或那些有其他严重并发症的人。尽管糖尿病患者获得的药物少于处方的危险(即药物供应不足)已经得到很好的认识，但获得过量药物的风险--超过维持依从性所需药物的120%--却远未被认识到。如果手头有大量不需要的药物，会促进患者过度使用或误用药物，那么可能会产生负面结果。在“封闭式”医疗系统中进行的一些研究发现，治疗糖尿病的药物供应过剩是昂贵和常见的，这种情况在高达50%的患者中发生，但在典型的美国实践中，糖尿病患者的药物供应过剩的程度和风险因素尚不清楚。目前也不清楚供应过剩可能在多大程度上对糖尿病患者构成安全风险，特别是那些临床复杂性较高的患者，他们可能难以管理和耐受处方药。这项拟议的研究通过1)描述糖尿病患者口服降糖、降压和降血脂药物过量的患病率和风险概况，以及2)检查过度供应对各种原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，以解决这些关键问题。我们的样本包括大约2440名糖尿病患者，他们在2006-2008年间由一个庞大的中西部多专科医生小组护理。我们的方法利用一个独特的数据资源，将电子健康记录数据链接到Medicare和一个大型当地健康维护组织(HMO)的管理数据。我们将使用滞后Logistic回归结合倾向分数来估计供应过剩对负面结果的影响，以调整几个潜在的混杂来源。这项研究将有助于明确糖尿病患者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的不良药物事件奠定基础。 公共卫生相关性：我们建议检查成人糖尿病患者药物供应过剩的预测因素和后果-获得的药物超过维持依从性所需的药物。糖尿病药物的过量供应可能会导致患者在遵循治疗方案时出错，并导致负面结果，但患者面临的健康风险仍未确定。我们的调查结果将确定未被认识到的糖尿病患者安全风险的范围，并为改进药物管理和减少这种常见、昂贵和难以管理的疾病中的不良药物事件的设计提供信息。

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.