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No adherencia a la medicación relacionada con los costos y el gasto en necesidades básicas después de la
Jeanne M Madden1, Amy J Graves, Fang Zhang
1Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, Massachusetts 02215, USA. jeanne_madden@hms.harvard.edu
JAMA
|April 24, 2008
Resumen
La implementación de la Parte D de Medicare condujo a una disminución significativa en la no adherencia a la medicación relacionada con los costos (CRN) y la renuncia a las necesidades básicas. Sin embargo, los beneficiarios más enfermos no vieron una reducción neta de CRN.
Área de la Ciencia:
- Servicios de salud Servicios de salud Investigación Investigación.
- Política de salud pública Política de salud pública.
- Medicina Geriátrica La medicina geriátrica es una especialidad de la medicina geriátrica.
Sus antecedentes:
- La no adherencia a la medicación relacionada con el costo (CRN) afecta significativamente a las personas mayores y discapacitadas en los Estados Unidos.
- El efecto de la cobertura de medicamentos recetados de Medicare (Parte D) en el CRN sigue siendo en gran medida desconocido.
Objetivo del estudio:
- Evaluar el impacto de la Parte D de Medicare en el CRN y la práctica de renunciar a las necesidades básicas para pagar los medicamentos.
- Para cuantificar los cambios en estos comportamientos antes y después de la implementación de la Parte D.
Principales métodos:
- Un diseño de estudio a nivel de población comparó los resultados entre 2005 y 2006 (antes y después de la Parte D) con los cambios históricos (2004-2005).
- Se utilizaron datos de la Encuesta de Beneficiarios Corrientes de Medicare (n=24,234), una muestra representativa a nivel nacional.
- Regresión logística empleada, control de datos demográficos, estado de salud y tendencias históricas.
Principales resultados:
- La prevalencia general de NRC disminuyó del 14,1% en 2005 al 11,5% en 2006.
- El gasto menos en necesidades básicas disminuyó del 11,1% en 2005 al 7,6% en 2006.
- Se observaron reducciones significativas en el CRN y en la renuncia a las necesidades básicas, especialmente en los beneficiarios con buena o excelente salud. Sin embargo, los beneficiarios con salud de buena a mala salud no mostraron una disminución significativa en CRN.
Conclusiones:
- La implementación de la Parte D de Medicare se asoció con una reducción modesta pero significativa de CRN y la renuncia a las necesidades básicas.
- De manera crítica, los beneficiarios más enfermos (de buena a mala salud) no experimentaron una disminución neta en CRN, lo que pone de relieve los desafíos persistentes.
- Es posible que se necesiten intervenciones adicionales para abordar la CRN entre los beneficiarios de Medicare vulnerables y de alta necesidad.
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