Effect of multiple pharmacy use on medication adherence and drug-drug interactions in older adults with Medicare Part D.

摘要: Objectives: To assess the association between multiple pharmacy use and medication adherence potential drug�drug interactions (DDIs) in older adults. Design: Cross-sectional propensity score-weighted analysis. Setting: 2009 claims data. Participants: A nationally representative sample of 926,956 Medicare Part D beneficiaries aged 65 continuously enrolled fee-for-service that year who filled one or more prescriptions at a community retail mail order pharmacy. Measurements: Multiple was defined as concurrent (overlapping time periods) sequential (non-overlapping ?2 pharmacies year. Medication calculated using proportion days covered 0.80 greater for eight therapeutic categories (beta-blockers, renin angiotensin system antagonists, calcium channel blockers, statins, sulfonylureas, biguanides (metformin), thiazolidinediones, dipeptidyl peptidase-IV inhibitors). Potential DDIs arising from certain drugs across broad set classes were filling two interacting drugs. Results: Overall, 38.1% used pharmacies. Those (concurrently sequentially) consistently had higher adjusted odds nonadherence (ranging 1.10 to 1.31, P < .001) all chronic assessed after controlling sociodemographic, health status, access care factors than single users. The predicted probability exposure DDI also slightly those concurrently (3.6%) users (3.2%, ratio (AOR) = 1.11, 95% confidence interval (CI) 1.08�1.15) but lower individuals sequentially (2.8%, AOR 0.85, CI 0.81�0.91). Conclusions: Filling associated with medications small statistically significant likelihood