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首页> 外文学位 >The determinants of antiretroviral therapy adherence and the relationship of healthcare expenditures to adherence among Florida medicaid-insured patients diagnosed with HIV or AIDS.
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The determinants of antiretroviral therapy adherence and the relationship of healthcare expenditures to adherence among Florida medicaid-insured patients diagnosed with HIV or AIDS.

机译：抗逆转录病毒疗法依从性的决定因素，以及在诊断为HIV或AIDS的佛罗里达州接受医疗保险的患者中，医疗支出与依从性的关系。

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摘要

esearch supports the clinical and societal benefits of antiretroviral treatment (ART) for people living with HIV or AIDS (PLWHA). However, factors associated with ART adherence and the relationship of ART adherence to total healthcare expenditures are not well understood. The research data included Florida Medicaid claims for five years (July 2006 through June 2011). All subjects (n=514) were HIV-positive, adult, non-pregnant, and ART naive for at least 12 months prior to their 24 month measurement period. Each subject was categorized as adherent (>90%) or non-adherent (<90%) based upon medication possession ratios (MPR). Total expenditures were payments Medicaid made to providers and pharmacies. Objective 1 modeled the logit probability of a subject being non-adherent to ART (versus adherent). Certain factors were expected to have significant negative associations with non-adherence to ART, including females, older age group, AIDS diagnosis, adherence to antidepressants, severe mental illness, meeting the minimum recommended number of outpatient visits, ART regimen type, number of medications in the ART regimen, residing in a county with a high median income, and residing in a county with an urban population density. The variables expected to have significant positive associations included race/ethnicity, substance or alcohol abuse diagnosis, depression or anxiety diagnoses, disease progression from HIV to AIDS, discontinuous Medicaid coverage, Medicaid eligibility type, and co-morbidity count levels. The Objective 1 results showed that all non-white race/ethnicity categories had at least twice the odds of being classified as non-adherent. Also, increasing numbers of concurrent ART medications significantly predicted non-adherence; the odds ratio for three to five ART medications was 2.04 (95% CI=1.04-4.01, p<.05), and six or more prescriptions category odds ratio was 4.58 (95% CI=1.82-11.56, p<.01), as compared to a single medication. Finally, a chronic diseases diagnosis was protective against non-adherence (OR=.46, 95% CI=.26-.84, p<.01), as was adherence to antidepressants (OR=.28, 95% CI=.14-.54, p<.01). In Objective 2, it was expected that the ART adherence group, the explanatory variable, would have significantly less monthly mean total healthcare expenditures, the outcome variable. For each of the HIV-positive (n=232) and the AIDS-diagnosed (n=270) groups, a generalized linear model predicted the mean total expenditures for the ART non-adherence group (<90% MPR) versus the ART adherence group, controlling for other factors. For the HIV-positive subjects, the predicted mean total healthcare expenditures for the ART non-adherent group was
机译：esearch支持抗逆转录病毒疗法（ART）对艾滋病毒或艾滋病患者（PLWHA）的临床和社会益处。然而，与抗逆转录病毒治疗依从性相关的因素以及抗逆转录病毒治疗依从性与总医疗保健支出之间的关系尚不清楚。研究数据包括五年（2006年7月至2011年6月）的佛罗里达医疗补助索赔。所有受试者（n = 514）在其24个月的测量期之前至少12个月均为HIV阳性，成年，未怀孕和未接受ART治疗。根据药物拥有率（MPR）将每个受试者分为依从性（> 90％）或不依从性（<90％）。总支出是Medicaid向提供者和药房支付的款项。目标1对受试者不遵守ART（相对于坚持）的logit概率进行建模。预期某些因素与不坚持抗逆转录病毒疗法具有显着的负相关性，包括女性，年龄较大的人群，艾滋病诊断，抗抑郁药的依从性，严重的精神疾病，达到门诊就诊的最低推荐次数，抗逆转录病毒治疗方案的类型，药物的数量在ART方案中，居住在收入中位数较高的县，居住在城市人口密度高的县。预期具有显着正相关的变量包括种族/民族，药物或酒精滥用诊断，抑郁或焦虑症诊断，疾病从HIV到AIDS的进展，不连续的医疗补助覆盖率，医疗补助资格类型和合并症计数水平。目标1的结果表明，所有非白人种族/族裔类别被分类为非依从性的几率至少是其两倍。同样，同时使用抗逆转录病毒药物的数量越来越多，这也预示了药物的不依从性。三到五种抗逆转录病毒药物的比值比是2.04（95％CI = 1.04-4.01，p <.05），六个或更多处方类别比值比是4.58（95％CI = 1.82-11.56，p <.01） ，与单一药物相比。最后，慢性疾病的诊断可以预防不依从性（OR = .46，95％CI = .26-.84，p <.01），对抗抑郁药的依从性也是如此（OR = .28，95％CI =。 14-.54，p <.01）。在目标2中，预计ART依从性组（解释变量）的月平均医疗总支出（结局变量）将大大减少。对于每个HIV阳性（n = 232）和经AIDS诊断（n = 270）组，广义线性模型预测了ART非依从组（<90％MPR）相对于ART依从性的平均总支出组，控制其他因素。对于HIV阳性受试者，ART非依从组的预计平均医疗总支出为

著录项

  • 作者

    Pruitt, Zachary.;

  • 作者单位

    University of South Florida.;

  • 授予单位 University of South Florida.;
  • 学科 Health care management.
  • 学位 Ph.D.
  • 年度 2013
  • 页码 172 p.
  • 总页数 172
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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