Ligang Liu, Armando Silva Almodóvar, Milap C Nahata
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引用次数: 0
Abstract
Background: Medication adherence in Medicare-enrolled older adults with asthma and chronic obstructive pulmonary disease (COPD) before and during the coronavirus disease 2019 (COVID-19) pandemic is unknown.
Objectives: To evaluate medication adherence and determinants of high adherence before and during the COVID-19 pandemic in this population.
Design: Retrospective cohort study.
Methods: The proportion of days covered (PDC) reflected medication adherence from January to July 2019 and from January to July 2020. Patients <65 years of age, with COPD or asthma alone, or with cystic fibrosis were excluded. Paired t tests were used to assess adherence changes. Logistic regression explored association of age, sex, diagnosis of depression, number of medications, medication-related problems, prescribers, pharmacies, controller medication classes, albuterol rescue inhaler fills, oral corticosteroid fills, and having a 90-day supply with high adherence (PDC ⩾ 80%).
Results: This analysis included 989 patients. In this cohort, 61.2% of patients received oral corticosteroids. Over 60% of patients had ⩾3 rescue fills in both 2019 and 2020. Medication adherence to controller medications significantly decreased for all controller medications (p < 0.001) in 2020. In 2019 and 2020, number of controller medication classes and having a 90-day supply were associated with high adherence (p < 0.001). In 2019, variables associated with high adherence also included number of medication-related problems and having ⩾3 albuterol rescue inhalers (p < 0.001).
Conclusion: Medication adherence to controllers significantly decreased during the pandemic among older adults with asthma and COPD. Patients with multiple controller classes and a 90-day supply were more likely to be highly adherent. A 90-day supply of medications should be used to facilitate access to medication during the pandemic. Healthcare professionals should assess medication adherence, resolve the barriers of adherence and medication-related problems to achieve desired clinical outcomes among older adults with both asthma and COPD.
背景：在2019冠状病毒病（新冠肺炎）大流行之前和期间，患有哮喘和慢性阻塞性肺病（COPD）的老年人的药物依从性尚不清楚。目的：评估该人群在新冠肺炎大流行之前和期间的药物依从性和高依从性的决定因素。设计：回顾性队列研究。方法：覆盖天数比例（PDC）反映了2019年1月至7月和2020年1月到7月的药物依从性。患者t检验用于评估依从性变化。Logistic回归分析了年龄、性别、抑郁症诊断、药物数量、药物相关问题、处方医生、药房、对照药物类别、沙丁胺醇抢救吸入器填充物、口服皮质类固醇填充物以及90天供应量与高依从性的关系（PDC ⩾ 结果：本分析包括989例患者。在该队列中，61.2%的患者接受了口服皮质类固醇治疗。在2019年和2020年，超过60%的患者进行了⩾3次抢救。所有对照药物的药物依从性均显著降低（p p p 结论：在新冠疫情期间，患有哮喘和慢性阻塞性肺病的老年人对控制器的药物依从性显著降低。具有多个控制器类别和90天供应的患者更有可能具有高度粘附性。应使用90天的药物供应，以便于在疫情期间获得药物。医疗保健专业人员应评估药物依从性，解决依从性障碍和药物相关问题，以在患有哮喘和慢性阻塞性肺病的老年人中实现预期的临床结果。
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