Medication Adherence and Social Disparities in Diabetes

糖尿病的药物依从性和社会差异

基本信息

批准号：
7912870
负责人：
Andrew John Karter
金额：
$ 40.13万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-13 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7912870
关键词：
Accounting Adherence Adverse effects American Antihypertensive Agents Antilipemic Agents Attention Behavior Blood Pressure Boxing California Cholesterol Clinical Complement Data Diabetes Mellitus Disadvantaged Dose Economically Deprived Population Electronics Epidemiologic Studies Evaluation Future Health Health Insurance Health Personnel Hypoglycemic Agents Intervention Literature Longitudinal Studies Low income Low-Density Lipoproteins Maintenance Managed Care Mediator of activation protein Medical Medicine Minority Non-Insulin-Dependent Diabetes Mellitus Outcome Patients Pattern Pharmaceutical Preparations Pharmacy facility Phase Physicians Play Population Population Heterogeneity Population Study Prevalence Public Health Quality of Care Recording of previous events Records Registries Relative (related person)Risk Factors Role Sampling Shapes Staging Study Subject Subgroup System Validation Variant Vulnerable Populations Writing cost design diabetic patient follow-up health care service utilization health disparity medication compliance member population based public health relevance response social social disparities social group socioeconomics

项目摘要

DESCRIPTION (provided by applicant): Poor medication adherence is a serious public health problem in diabetes and may play a role in perpetuating inadequate risk factor control, particularly among minority and socioeconomically- disadvantaged patients. Extant medical literature has underestimated rates of nonadherence because it relies almost exclusively on adherence estimates derived from refill history among ongoing users, and thus fails to account for the large number of patients who are prescribed new therapies but never become ongoing users. We show preliminary evidence that one quarter of treatment-naove patients prescribed a new cardiometabolic medication (antihypertensive, antilipemic or antihyperglycemic) never fill ("primary non-adherence") or never refill ("early non-persistence") the new prescription and thus fail to become ongoing users. A more comprehensive understanding of adherence is needed; one that includes, first, all stages of medication adherence, from new prescription to therapy discontinuation and, second, how the stages of adherence shape social disparities in clinical outcomes. We propose a longitudinal study of diabetic patients prescribed a new cardiometabolic medication to assess social disparities in medication adherence, explanatory factors and clinical consequences. This "new prescription design" will take advantage of a pharmacy management system that electronically records physicians' prescription orders, dose changes, discontinuation orders and incident side effects. Study subjects will include members of the Kaiser Permanente Northern California Diabetes Registry, a large, well-characterized, ethnically-diverse, insured population of managed care patients with diabetes mellitus. Socially-disadvantaged patients are well represented in this study population, which has uniform access to and quality of care, unlike most population-based samples. Given that 92% of Americans with diabetes have health insurance, findings from this insured population should have broad public health relevance. Given this will be the first, large epidemiological study to assess primary medication adherence, it will provide a more comprehensive understanding of how social disparities in medication adherence shape disparities in diabetes-related risk factor control and inform the design of future interventions aimed at reducing health disparities. PUBLIC HEALTH RELEVANCE: Project Narrative This study will evaluate whether diabetes, blood pressure and cholesterol medications, are taken by patients with diabetes as prescribed ("adherence"), emphasizing social patterns in adherence, clinical consequences and reasons for differences in therapy initiation, maintenance and discontinuation. We will take advantage of new electronic prescribing data to evaluate medication adherence starting from the point the doctor writes the new prescription. Study findings should be generalizable to the 92% of Americans with diabetes who have health insurance, and provide a more comprehensive understanding of medication adherence in diabetes.

描述（由申请人提供）：服药依从性差是糖尿病中的一个严重的公共卫生问题，可能会导致风险因素控制持续不充分，特别是在少数族裔和社会经济弱势群体患者中。现有的医学文献低估了不依从率，因为它几乎完全依赖于从持续使用者的补充历史中得出的依从性估计，因此无法解释大量接受新疗法但从未成为持续使用者的患者。我们显示的初步证据表明，四分之一的初治患者开出新的心脏代谢药物（抗高血压、抗血脂或抗高血糖），但从未服用（“初次不依从”）或从未重新服用（“早期不坚持”）新处方，因此无法成为持续用户。需要对依从性有更全面的理解；其中包括：第一，药物依从性的所有阶段，从新处方到治疗停止；第二，依从性阶段如何影响临床结果的社会差异。我们建议对糖尿病患者进行一项新的心脏代谢药物的纵向研究，以评估药物依从性、解释因素和临床后果方面的社会差异。这种“新处方设计”将利用药房管理系统，以电子方式记录医生的处方单、剂量变化、停药单和副作用事件。研究对象将包括北加州凯撒医疗机构糖尿病登记处的成员，该登记处是一个规模庞大、特征明确、种族多元化的受保糖尿病管理患者群体。与大多数基于人群的样本不同，本研究人群中社会弱势患者的比例很高，他们获得统一的护理服务和质量。鉴于 92% 的美国人糖尿病患者都有健康保险，这一受保人群的调查结果应该具有广泛的公共卫生相关性。鉴于这将是第一个评估主要药物依从性的大型流行病学研究，它将更全面地了解药物依从性的社会差异如何影响糖尿病相关风险因素控制的差异，并为未来旨在降低健康水平的干预措施的设计提供信息差异。公共健康相关性：项目叙述本研究将评估糖尿病患者是否按照处方服用糖尿病、血压和胆固醇药物（“依从性”），强调依从性的社会模式、临床后果以及治疗开始、维持方面差异的原因和停产。我们将利用新的电子处方数据从医生开出新处方开始评估用药依从性。研究结果应该适用于 92% 拥有健康保险的美国糖尿病患者，并提供对糖尿病药物依从性的更全面的了解。