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首页> 外文期刊>Patient Preference and Adherence >Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database
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Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database

机译：老年2型糖尿病患者的依从性与预后之间的关联：来自Medicare补充数据库的证据

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Objective: To examine the association between adherence to glucose-lowering agents and patient outcomes, including costs, acute-care resource utilization, and complications, in an older, type 2 diabetic population. Data and methods: The study used Truven’s Medicare Supplemental database from July?1, 2009 to June 30, 2014. Patients aged 65 years or older were included if they had at least two type?2 diabetes diagnoses and received a glucose-lowering agent from July 1, 2010 through June?30, 2011. Multivariable analyses examined the relationships among 3-year patient outcomes and levels of adherence, proxied by the proportion of days covered. Outcomes included all-cause medical costs, diabetes-related medical costs, acute-care resource utilization, and acute complications. Results: In this study (N=123,235), higher adherence was linked to reduced costs and improved health outcomes. For example, comparing an individual with adherence of proportion of days covered <20% to one with proportion of days covered ≥80% illustrates an average saving of $28,824 in total 3-year costs. Furthermore, a 1% increase in adherence among 1,000?patients was associated with all-cause savings of $65,464 over 3 years. The probability of a hospitalization, an emergency room (ER) visit, or an acute complication decreased monotonically as adherence levels got higher, as did the number of hospitalizations, ER visits, and days hospitalized ( P <0.005). Conclusion: Higher adherence was associated with substantially less need for acute care, as indicated by a lowered probability of hospitalization or ER use, a reduced risk of an acute complication, and a decreased number of hospitalizations, ER visits, and days hospitalized. Higher adherence was also generally associated with lower all-cause and diabetes-related total costs, despite higher drug costs. These lower total costs were driven by the diminished acute care and outpatient costs. Results suggest that higher glucose-lowering agent adherence is associated with significant benefits for payers and older patients with type 2 diabetes.
机译：目的：研究在年龄较大的2型糖尿病人群中，降糖药依从性与患者预后之间的关联，包括成本，急救资源利用和并发症。数据和方法：该研究使用2009年7月1日至2014年6月30日之间的Truven Medicare Supplemental数据库。如果年龄至少65岁或以上的患者至少两次诊断出2型糖尿病，并且接受了降糖药，则纳入研究从2010年7月1日到2011年6月30日。多变量分析检查了3年患者预后与依从性水平之间的关系，并以覆盖天数的比例为代表。结果包括全因医疗费用，糖尿病相关医疗费用，急救资源利用和急性并发症。结果：在这项研究（N = 123,235）中，更高的依从性与降低成本和改善健康状况有关。例如，将某人的遵守天数覆盖率<20％的人与遵守天数覆盖率≥80％的人进行比较，可以说明三年总成本平均节省了28,824美元。此外，在1,000名患者中，依从性增加1％，可在3年内节省65,464美元。随着依从性水平的提高，住院，急诊就诊或急性并发症的可能性单调降低，住院次数，急诊就诊次数和住院天数也均降低（P <0.005）。结论：较高的依从性与减少急症护理的相关性，如住院或使用ER的可能性降低，发生急性并发症的风险降低以及住院，急诊就诊次数和住院天数减少。尽管药物费用较高，但依从性较高的人群通常也因较低的全因病和与糖尿病相关的总费用而相关。这些较低的总费用是由于急诊和门诊费用的减少所致。结果表明，对于降血脂药和老年2型糖尿病患者，更高的降糖药依从性具有明显的益处。

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