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以及地理空间方法来确定药房的地理可及性如何影响美国老年人心血管药物依从性的地方差异。这个问题处于老年人少数群体健康和健康政策的前沿。考虑到心血管药物对健康和生存的益处，以及最近老年人处方药覆盖范围的扩大，未能减少处方药物依从性的差异。此外，几项全国性研究表明，坚持服药的差异不是由于收入、教育或健康保险方面的个人差异，并表明老年少数群体在坚持服用处方药方面可能会遇到白人没有遇到的障碍，包括药房的可及性。我们的初步分析表明，在药房密度和他汀类药物和储物柜的依从性方面存在实质性的地方差异。在拟议的研究中，我们将利用超过5000万美国人的地理编码纵向患者级药房索赔数据，以及美国药房位置信息，进行一项观察性队列研究，以检查药房的地理可及性或药房密度如何影响常用心血管药物（包括他汀类药物和阻滞剂）依从性的差异。在美国65岁及以上的成年人中，我们还将研究个人因素（如年龄、多药房）和社区因素（如贫困、车辆所有权）通常与依从性相关的作用。最后，我们将应用地理空间方法，利用在社区层面汇总的患者水平依从性来确定老年少数民族社区中最容易出现低依从性的风险。我们提出的工作是创新的，因为它将是第一个将地理空间方法纳入分析老年人药物依从性差异的研究。我们的数据还将允许以前所未有的粒度检查影响国家和地方各级依从性差异的个人和社区一级因素。我们对药房地理可达性的关注是新颖的，考虑到药店在美国老年人医疗保健服务中日益重要，但往往被忽视。就预期结果而言，所提出的工作有望为政策制定者、从业人员和研究人员提供新的知识，以制定创新的政策和计划，以改善老年人药物依从性的差异。这一点尤其重要，因为越来越多的少数民族人口参加了公共保险，医疗保险/医疗补助服务中心已经批准了质量措施，包括坚持使用心血管药物，这些措施尚未在差异背景下进行检查。预计这些结果将产生积极影响，因为随着药房的服务范围继续扩大，包括预防性保健，药房对健康差距的重要性和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.