Developing an Integrated Longitudinal Dataset for Patient-Centered Outcome Measures in Cost-Related Medication Nonadherence.

Cost-related medication nonadherence (CRN) is an important patient-centered outcome measure. Longitudinal follow-up of CRN is rare. We propose to develop a novel integrated dataset to study CRN longitudinally. A dataset of 2000 Medicare beneficiaries at high risk of hospitalization surveyed quarterly on CRN and followed up individually for 8 quarters between 2013 and 2018 was linked to Medicare files. A metric of CRN categorizing persistent, intermittent, and transient CRN during the 8 quarters was developed. An ordered logit model and a logit model were developed to assess the factors influencing CRN overall and persistent CRN, respectively. A total of 1761 patients were included in the analysis, among whom 869 (49.3%) reported CRN at least once in the 8-quarter study period, 178 (10%) reported persistent CRN, 395 (22.4%) reported intermittent CRN, and 296 (16.8%) reported transient CRN. The conditional effect in the logit model for persistent CRN revealed that baseline dual eligibility was negatively associated (adjusted odds ratio = 0.45, P < 0.01) and depression positively associated (adjusted odds ratio = 1.55, P = 0.01) with persistent CRN. The marginal analysis in the ordered logit model revealed a clear pattern of higher probabilities of persistent and intermittent CRN at younger ages while transient CRN was flat. Among the 252 subjects who were deceased, 31 (12.3%) reported persistent CRN, compared with 147 (9.74%) who were alive (P = 0.21 by χ2 test). A significant number of patients reported persistent CRN, including those who were at the end of life. Research is critically needed to understand behavioral patterns among the younger Medicare population.

与费用相关的药物不依从性（CRN）是一项重要的以患者为中心的结果衡量指标。对CRN的纵向随访很罕见。 我们提议开发一个新的综合数据集来纵向研究CRN。 一个包含2000名有高住院风险的医疗保险受益人数据集，这些人在2013年至2018年期间每季度接受关于CRN的调查，并单独随访8个季度，该数据集与医疗保险档案相关联。开发了一种在8个季度期间对持续性、间歇性和短暂性CRN进行分类的CRN指标。分别建立了有序逻辑模型和逻辑模型来评估影响总体CRN和持续性CRN的因素。 共有1761名患者被纳入分析，其中869人（49.3%）在8个季度的研究期间至少报告过一次CRN，178人（10%）报告了持续性CRN，395人（22.4%）报告了间歇性CRN，296人（16.8%）报告了短暂性CRN。持续性CRN的逻辑模型中的条件效应显示，基线双重符合资格与持续性CRN呈负相关（调整后的优势比 = 0.45，P < 0.01），抑郁症与持续性CRN呈正相关（调整后的优势比 = 1.55，P = 0.01）。有序逻辑模型中的边际分析显示出一种明显的模式，即较年轻年龄组出现持续性和间歇性CRN的概率较高，而短暂性CRN则较为平稳。在252名死亡的受试者中，31人（12.3%）报告了持续性CRN，而在存活的受试者中这一比例为147人（9.74%）（通过卡方检验，P = 0.21）。 大量患者报告了持续性CRN，包括那些处于生命末期的患者。迫切需要进行研究以了解较年轻的医疗保险人群的行为模式。