의원급 만성질환관리제도 도입에 따른 국내 고혈압 환자의 복약 이행도 및 투약 지속도 변화양상 분석 (Effect of the Clinic-based Chronic Disease Management Program on the appropriateness of medication adherence and persistence in hypertension patients in Korea)

서지정보

· 발행기관 : 대한약학회
· 수록지 정보 : 약 학 회 지 / 61권 / 3호 / 135 ~ 146페이지
· 저자명 : 김정애, 이의경

초록

The Clinic-based Chronic Disease Management Program (CDMP), a multi-level intervention including co-paymentreduction and physician incentives, was introduced in 2012 in Korea to improve blood pressure and glycemic controlby strengthening the clinic’s function as primary care institutions in managing hypertension and diabetes. A pre-post retrospectivestudy was conducted using insurance-claims cohort data from 2010 to 2013 to evaluate CDMP’s effect on theappropriateness of medication adherence and persistence in hypertension patients. Hypertension patients were selected asCDMP group, while dyslipidemia patients were the control group. Study groups were further categorized as shifters to clinicor non-shifters to clinic on the basis of whether hospital use changed to clinic use during the study period. Adherence wasmeasured by medication possession ratio (MPR) and appropriate-adherence was defined as MPR 0.8-1.1. Persistence wasmeasured by 12-month cumulative persistence rate. Logistic regression and Cox proportional hazard model were used toestimate the impact of CMPD on the appropriateness of medication adherence and persistence. The odds of achievingappropriate-adherence was 2.05 times higher and the risk of discontinuation of medication was 0.89 times lower amongshifters to clinic in hypertension group compared to non-shifters to clinic. No significant difference was verified among dyslipidemiagroup. CDMP was effective to improve medication adherence and persistence by significantly increasing probabilityto achieve appropriate-adherence and decreasing discontinuation risk of medication in patients with hypertension inKorea. Given these findings, our study suggests that CDMP should be further applied to other major chronic diseases notbeing limited to hypertension and diabetes.

영어초록

The Clinic-based Chronic Disease Management Program (CDMP), a multi-level intervention including co-paymentreduction and physician incentives, was introduced in 2012 in Korea to improve blood pressure and glycemic controlby strengthening the clinic’s function as primary care institutions in managing hypertension and diabetes. A pre-post retrospectivestudy was conducted using insurance-claims cohort data from 2010 to 2013 to evaluate CDMP’s effect on theappropriateness of medication adherence and persistence in hypertension patients. Hypertension patients were selected asCDMP group, while dyslipidemia patients were the control group. Study groups were further categorized as shifters to clinicor non-shifters to clinic on the basis of whether hospital use changed to clinic use during the study period. Adherence wasmeasured by medication possession ratio (MPR) and appropriate-adherence was defined as MPR 0.8-1.1. Persistence wasmeasured by 12-month cumulative persistence rate. Logistic regression and Cox proportional hazard model were used toestimate the impact of CMPD on the appropriateness of medication adherence and persistence. The odds of achievingappropriate-adherence was 2.05 times higher and the risk of discontinuation of medication was 0.89 times lower amongshifters to clinic in hypertension group compared to non-shifters to clinic. No significant difference was verified among dyslipidemiagroup. CDMP was effective to improve medication adherence and persistence by significantly increasing probabilityto achieve appropriate-adherence and decreasing discontinuation risk of medication in patients with hypertension inKorea. Given these findings, our study suggests that CDMP should be further applied to other major chronic diseases notbeing limited to hypertension and diabetes.

참고자료

· 없음