費用関連の薬物不服従と,Medicare Part Dの実施後の基本的ニーズへの支出
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
まとめ
メディケア・パートDの実施により,費用関連の薬物不服従 (CRN) が大幅に減少し,基本的ニーズを放棄しました. しかし,最も病気の受給者には,CRNの純減少が見られなかった.
科学分野:
- 医療サービス 研究 医療サービス
- 公共衛生政策 公共衛生政策
- ゲリアトリック・メディシン (老年医学)
背景:
- コスト関連の薬物不服従 (Cost-Related Medication Non-adherence,CRN) は,米国の高齢者や障害者に対して重大な影響を及ぼしています.
- メディケアによる処方薬の適用 (Part D) がCRNに与える影響は,依然としてほとんど不明である.
研究 の 目的:
- Medicare Part DがCRNに与える影響と,医薬品を購入するために基本的なニーズを放棄する慣習を評価する.
- パートDの実施前と後にこれらの行動の変化を定量化するために.
主な方法:
- 人口レベルでの研究デザインは,2005年から2006年までの結果 (前後D部分) と,過去の変化 (2004年から2005年) を比較した.
- メディケア現在の受給者調査 (n=24,234) のデータを使用し,全国的に代表的なサンプルです.
- 人口統計,健康状態,および過去の傾向を制御するロジスティック回帰を使用しました.
主要な成果:
- 総合的なCRNの罹患率は2005年の14.1%から2006年の11.5%に減少した.
- 基本的ニーズへの支出は2005年の11.1%から2006年の7.6%に減少した.
- CRNと基本的ニーズを放棄する人の有意な減少が観察され,特に健康状態が良好または良好な受益者の間で顕著でした. しかし,健康状態がかなり悪い受給者には,CRNの有意な減少は見られなかった.
結論:
- メディケア・パートDの実施は,CRNの控えめだが有意な減少と,基本的ニーズへの放棄と関連していた.
- 重要なことに,最も病気の受給者 (健康状態の良さまたは不良) はCRNの純減少を経験せず,継続的な課題を強調しました.
- 脆弱な,高いニーズを持つメディケア受給者の間でCRNに対処するために,さらなる介入が必要になる可能性があります.
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