Patient noncompliance in the managed care setting - The case of medical therapy for glaucoma

被引:72
作者
Gurwitz, JH
Yeomans, SM
Glynn, RJ
Lewis, BE
Levin, R
Avorn, J
机构
[1] Meyers Primary Care Inst, Fallon Healthcare Syst, Worcester, MA 01608 USA
[2] Univ Massachusetts, Med Ctr, Worcester, MA 01605 USA
[3] Brigham & Womens Hosp, Program Anal Clin Strategies, Dept Med, Boston, MA 02115 USA
[4] Brigham & Womens Hosp, Dept Med, Div Gerontol & Prevent Med, Boston, MA 02115 USA
[5] Harvard Univ, Sch Med, Boston, MA 02115 USA
关键词
health maintenance organization; managed care; compliance; adherence; glaucoma;
D O I
10.1097/00005650-199803000-00012
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
OBJECTIVES. The authors identify demographic and clinical characteristics associated with noncompliance in patients beginning medical therapy for the treatment of glaucoma in a managed care setting. METHODS. The authors describe a retrospective cohort study in a group-model health maintenance organization in Massachusetts. Patients were members of the health maintenance organization who were newly initiated on topical drug therapy to treat open-angle glaucoma during the period January 1, 1987 through December 31, 1990, who met eligibility requirements, and who had evidence of health services utilization for a 12-month follow-up period. For all study subjects, we determined the number of days without available therapy for glaucoma during the 12-month period. Study subjects who did not fill prescriptions adequate to provide medication to cover at least 80% of days during the study period were considered noncompliant. Logistic regression analysis was used to assess demographic and clinical factors independently associated with noncompliance among patients initiated on medical therapy for the treatment of glaucoma. RESULTS. Of 616 subjects who met inclusion criteria, 152 (24.7%; 95% confidence interval, 21.3%-28.1%) met the study definition for noncompliance. These patients had an average number of days without therapy during the 12-month study period of 103.9 +/- 70.0 days compared with 6.8 +/- 19.5 days for those categorized as compliant. Of a variety of selected demographic and clinical characteristics, having fewer visits with an ophthalmologist during the study period (<2) was most strongly related to noncompliance (odds ratio 2.99; 95% confidence interval 2.03, 4.40). There were no differences in average intraocular pressure between the compliant and noncompliant groups during the study period. CONCLUSIONS. Noncompliance with prescribed medical therapy for glaucoma was found to be common in a managed care setting characterized by essentially unrestricted access to health care and medications. It remains difficult to identify noncompliant patients based on demographic and clinical characteristics. The use of automated prescription data to identify noncompliant patients is feasible in large managed health care insurance programs where such data are collected routinely for administrative purposes.
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页码:357 / 369
页数:13
相关论文
共 40 条
[1]  
[Anonymous], 1989, Analysis of binary data
[2]  
AYANIAN JZ, 1993, NEW ENGL J MED, V329, P331
[3]  
CANNER PL, 1980, NEW ENGL J MED, V303, P1038
[4]  
COHEN JW, 1989, HEALTH SERV RES, V24, P33
[5]  
CRAMER JA, 1989, JAMA-J AM MED ASSOC, V262, P1472
[6]   HOW OFTEN IS MEDICATION TAKEN AS PRESCRIBED - A NOVEL ASSESSMENT TECHNIQUE [J].
CRAMER, JA ;
MATTSON, RH ;
PREVEY, ML ;
SCHEYER, RD ;
OUELLETTE, VL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1989, 261 (22) :3273-3277
[7]  
DARNELL JC, 1986, J AM GERIATR SOC, V34, P1
[8]  
EPSTEIN DL, 1989, OPHTHALMOLOGY, V96, P1460
[9]   UNDERSTANDING AND IMPROVING PATIENT COMPLIANCE [J].
ERAKER, SA ;
KIRSCHT, JP ;
BECKER, MH .
ANNALS OF INTERNAL MEDICINE, 1984, 100 (02) :258-268
[10]   A NATIONAL SURVEY OF THE ARRANGEMENTS MANAGED-CARE PLANS MAKE WITH PHYSICIANS [J].
GOLD, MR ;
HURLEY, R ;
LAKE, T ;
ENSOR, T ;
BERENSON, R .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (25) :1678-1683