背景:Phramongkutklao医院是泰国最大的军事医院之一。从2016年开始,实施了一项制度政策,将药物处方长度从30天增加到90天。然而,目前还没有正式调查这项政策如何影响医院患者的用药依从性.因此,这项研究评估了在Phramongkutklao医院接受治疗的血脂异常和2型糖尿病患者的处方长度如何影响药物依从性.
方法:这项实施前研究根据2014年至2017年医院数据库中记录的信息,比较了接受30天和90天处方长度的患者。其中,我们使用药物占有比(MPR)来评估患者的依从性.以全民参保患者为重点,我们采用差异差异方法来检查政策实施前后的依从性变化,然后进行了逻辑回归,以检验预测因子和依从性之间的关联.
结果:我们分析了2,046例患者的数据,将等量的1,023分为对照组(90天处方长度无变化)和干预组(从30天至90天处方长度变化)。首先,我们发现,在干预组中,血脂异常和糖尿病患者的处方长度增加与4%和5%的MPRs增加相关,分别。第二,我们发现服药依从性与性别相关,合并症,住院史,以及处方药的数量。
结论:在血脂异常和2型糖尿病患者中,将处方时间从30天增加到90天可以改善药物依从性。这表明政策变化对于本研究考虑的医院患者是成功的。
BACKGROUND: Phramongkutklao Hospital is one of the largest military hospitals in Thailand. Beginning in 2016, an institutional policy was implemented in which medication prescription length was increased from 30 to 90 days. However, there have been no formal investigations into how this policy has impacted medication adherence among patients in hospitals. As such, this study evaluated how prescription length impacted medication adherence among dyslipidemia and type-2 diabetes patients who were treated at Phramongkutklao Hospital.
METHODS: This pre-post implementation study compared patients who received prescription lengths of 30 and 90 days based on information recorded in the hospital database between 2014 and 2017. Therein, we used the medication possession ratio (MPR) to estimate patient adherence. Focusing on patients with universal coverage insurance, we employed the difference-in-difference method to examine changes in adherence from before and after policy implementation, then conducted a logistic regression to test for associations between the predictors and adherence.
RESULTS: We analyzed data from a total of 2,046 patients, with equal amounts of 1,023 placed into the control group (no change to 90-day prescription length) and intervention group (change from 30 to 90-day prescription length). First, we found that increased prescription length was associated with 4% and 5% higher MPRs among dyslipidemia and diabetes patients in the intervention group, respectively. Second, we found that medication adherence was correlated with sex, comorbidities, history of hospitalization, and the number of prescribed medications.
CONCLUSIONS: Increasing the prescription length from 30 to 90 days improved medication adherence in both the dyslipidemia and type-2 diabetes patients. This shows that the policy change was successful for patients in the hospital considered for this study.