药物坚持的社会经济,人口和药物类别决定因素:一个回顾性队列研究
Nikolay Lukyanchikov1, Joshua S Choi1,2, Phillip B Warner1
1Department of Biomedical Informatics, University of Utah, Salt Lake City.
Journal of managed care & specialty pharmacy
|February 4, 2026
概括
药物坚持与保险,种族和社会脆弱性有关. 某些药物类别,如高血压和心力衰竭的药物类别,表现出更高的坚持率. 个人因素对坚持有很大影响,而社区因素对坚持有很小影响.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 健康的社会决定因素
- 药物经济学 药物经济学
背景情况:
- 在不同的社会经济和人口群体中,药物服药程度有很大差异.
- 之前的研究经常使用广泛的社会经济措施;本研究使用细粒度的社区级数据探索了遵守.
- 了解这些模式对于改善患者结果和医疗保健公平至关重要.
研究的目的:
- 量化社会经济地位,人口因素和药物类别之间的关联在门诊药物坚持.
- 调查细分的社区层面的社会经济措施对遵守的影响.
- 为了确定特定的患者群体和药物类型的坚持挑战.
主要方法:
- 一项回顾性队列研究分析了从2022年1月到2024年1月为189,832名成年人的1,252,986份药物订单.
- 数据来源包括药房记录,电子健康记录和Surescripts.
- 多变量回归以保险,种族,性别,就业状况,药物类别和社会脆弱性指数四分位数作为共变量来建模药物坚持 (覆盖日数的比例).
主要成果:
- 与商业保险人员相比,医疗补助和无保险患者的保险遵守率较低. 医疗保险的使用与改善的坚持有关.
- 观察到种族差异,黑人,夏威夷原住民/太平洋岛民和美国印第安人/阿拉斯加原住民患者的坚持率低于白人患者.
- 较高的社会脆弱性指数四分位数与降低的坚持有适度的关联,而特定的药物类 (抗高血压药,降胆固醇药,抗抑郁药,心力衰竭药物) 的坚持明显更高.
结论:
- 个人层面的因素,包括保险状况和种族,与药物坚持有很强的关联.
- 社区层面的社会经济脆弱性显示出与坚持的适度,但显著的关联.
- 这些发现凸显了针对社会经济和人口差异的有针对性的干预措施的必要性,以改善药物坚持.
相关概念视频
01:23Inhaled Medications
803
Inhaled medications are crucial for managing chronic obstructive pulmonary disease (COPD) and asthma. They are essential for effective treatment and control, ensuring optimal respiratory health and well-being. Inhaled medication delivers drugs directly to the lungs, providing a rapid onset of action and reducing systemic side effects compared to oral or injectable medications. Three primary types of inhalation devices are used to administer these medications: nebulizers, metered-dose inhalers...
803
01:18Endocarditis III: Medical Management
259
Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
259
01:14Myocarditis III: Medical Management
217
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
217
01:17Pericarditis III: Medical Management
361
The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
361
01:30Heart Failure V: Medical Management
330
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
330
01:26Mitral Stenosis III: Medical Management
308
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
308