吸入器的共同支付是否会影响治疗依从性和疾病结局?一项历史的、匹配的队列研究。

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL
Pragmatic and Observational Research Pub Date : 2017-04-18 eCollection Date: 2017-01-01 DOI:10.2147/POR.S132658
Jaco Voorham, Bernard Vrijens, Job Fm van Boven, Dermot Ryan, Marc Miravitlles, Lisa M Law, David B Price
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引用次数: 4

摘要

背景:哮喘和慢性阻塞性肺疾病(COPD)治疗的依从性已被证明取决于患者水平的因素,如疾病严重程度,以及药物水平的因素,如复杂性。然而,人们对处方收费的影响知之甚少——这是卫生保健系统层面的一个因素。本研究使用真实数据来调查共同支付是否会影响哮喘或COPD患者的依从性(实施和持久性)和疾病结局。方法:使用两个英国初级保健数据库进行匹配的历史队列研究。暴露的风险是处方的共同支付,这是英格兰大多数患者所要求的,但苏格兰没有。形成了两个比较队列:一个包括在英格兰全科诊所注册的患者,另一个包括在苏格兰注册的患者。纳入20-59岁的哮喘患者,或40-59岁的COPD患者,这些患者开始使用丙酸氟替卡松/沙美特罗新酸盐,与相反队列的患者相匹配,并在丙酸氟替卡松/沙美特罗新酸盐开始后随访1年。主要结局为良好的依从性,定义为药物持有率≥80%,并使用条件逻辑回归进行分析。次要结局包括恶化率。结果:付费队列中有1640例患者,即英格兰(哮喘1378例,COPD 262例),无付费队列中有619例患者,即苏格兰(哮喘512例,COPD 107例)。在两种疾病组中,付费组和无付费组中依从性良好的患者比例分别为34.3%和34.9%。在多变量模型中,各组间良好依从性的几率没有差异(比值比,1.04;95%置信区间0.85-1.27)。两组的急性加重率也无差异。结论:在英格兰和苏格兰注册的匹配患者的依从性没有差异,这表明处方收费对治疗的依从性没有影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study.

Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study.

Background: Adherence to asthma and chronic obstructive pulmonary disease (COPD) treatment has been shown to depend on patient-level factors, such as disease severity, and medication-level factors, such as complexity. However, little is known about the impact of prescription charges - a factor at the health care system level. This study used real-life data to investigate whether co-payment affects adherence (implementation and persistence) and disease outcomes in patients with asthma or COPD.

Methods: A matched, historical cohort study was carried out using two UK primary care databases. The exposure was co-payment for prescriptions, which is required for most patients in England but not in Scotland. Two comparison cohorts were formed: one comprising patients registered at general practices in England and the other comprising patients registered in Scotland. Patients aged 20-59 years with asthma, or 40-59 years with COPD, who were initiated on fluticasone propionate/salmeterol xinafoate, were included, matched to patients in the opposite cohort, and followed up for 1 year following fluticasone propionate/salmeterol xinafoate initiation. The primary outcome was good adherence, defined as medication possession ratio ≥80%, and was analyzed using conditional logistic regression. Secondary outcomes included exacerbation rate.

Results: There were 1,640 patients in the payment cohort, ie, England (1,378 patients with asthma and 262 patients with COPD) and 619 patients in the no-payment cohort, ie, Scotland (512 patients with asthma and 107 patients with COPD). The proportion of patients with good adherence was 34.3% and 34.9% in the payment and no-payment cohorts, respectively, across both disease groups. In a multivariable model, no difference in odds of good adherence was found between the cohorts (odds ratio, 1.04; 95% confidence interval, 0.85-1.27). There was also no difference in exacerbation rate.

Conclusion: There was no difference in adherence between matched patients registered in England and Scotland, suggesting that prescription charges do not have an impact on adherence to treatment.

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来源期刊
Pragmatic and Observational Research
Pragmatic and Observational Research MEDICINE, GENERAL & INTERNAL-
自引率
0.00%
发文量
11
期刊介绍: Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.
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