私人支付者的州远程医疗均等化法律对高血压药物治疗依从性的影响：在 COVID-19 大流行之前和期间。
Impact of State Telehealth Parity Laws for Private Payers on Hypertension Medication Adherence Before and During the COVID-19 Pandemic.
机构信息
Center for Population Health and Health Services Research, Department of Foundations of Medicine (D.Z., S.L.), New York University Grossman Long Island School of Medicine, Mineola.
Department of Population Health (D.Z.), New York University Grossman Long Island School of Medicine, Mineola.
出版信息
Circ Cardiovasc Qual Outcomes. 2024 Aug;17(8):e010739. doi: 10.1161/CIRCOUTCOMES.123.010739. Epub 2024 Jul 29.
BACKGROUND
Telehealth has emerged as an effective tool for managing common chronic conditions such as hypertension, especially during the COVID-19 pandemic. However, the impact of state telehealth payment and coverage parity laws on hypertension medication adherence remains uncertain.
METHODS
Data from the 2016 to 2021 Merative MarketScan Commercial Claims and Encounters Database were used to construct the study cohort, which included nonpregnant individuals aged 25 to 64 years with hypertension. We coded telehealth parity laws related to hypertension management in all 50 US states and the District of Columbia, distinguishing between payment and coverage parity laws. The primary outcomes were measures of antihypertension medication adherence: the average medication possession ratio; medication adherence (medication possession ratio ≥80%); and average number of days of drug supply. We used a generalized difference-in-differences design to examine the impact of these laws.
RESULTS
Among 353 220 individuals (mean [SD] age, 49.5 (7.1) years; female, 45.55%), states with payment parity laws were significantly linked to increased average medication possession ratio by 0.43 percentage point (95% CI, 0.07-0.79), and an increase of 0.46 percentage point (95% CI, 0.06-0.92) in the probability of medication adherence. Payment parity laws also led to an average increase of 2.14 days (95% CI, 0.11-4.17) in prescription supply, after controlling for state-fixed effects, year-fixed effects, individual sociodemographic characteristics and state time-varying covariates including unemployment rates, gross domestic product per capita, and poverty rates. In contrast, coverage parity laws were associated with a 2.13-day increase (95% CI, 0.19-4.07) in days of prescription supply but did not significantly increase the average medication possession ratio or probability of medication adherence.
CONCLUSIONS
State telehealth payment parity laws were significantly associated with greater medication adherence, whereas coverage parity laws were not. With the increasing adoption of telehealth parity laws across states, these findings may support policymakers in understanding potential implications on management of hypertension.
背景
远程医疗已成为管理高血压等常见慢性病的有效工具，尤其是在 COVID-19 大流行期间。然而，州远程医疗支付和覆盖均等化法律对高血压药物依从性的影响仍不确定。
方法
本研究使用 2016 年至 2021 年 Merative MarketScan 商业索赔和就诊数据库的数据构建了研究队列，其中包括年龄在 25 岁至 64 岁之间、患有高血压的非孕妇。我们对所有 50 个州和哥伦比亚特区与高血压管理相关的远程医疗均等化法律进行了编码，区分了支付和覆盖均等化法律。主要结局指标为抗高血压药物依从性的衡量指标：平均药物持有率；药物依从性（药物持有率≥80%）；以及平均药物供应天数。我们使用广义差分差异设计来检验这些法律的影响。
结果
在 353220 名患者中（平均[标准差]年龄，49.5[7.1]岁；女性占 45.55%），具有支付均等化法律的州与平均药物持有率提高 0.43 个百分点（95%置信区间，0.07-0.79）显著相关，药物依从性概率提高 0.46 个百分点（95%置信区间，0.06-0.92）。在控制了州固定效应、年固定效应、个体社会人口统计学特征以及包括失业率、人均国内生产总值和贫困率在内的州时变协变量后，支付均等化法律还导致处方供应平均增加 2.14 天（95%置信区间，0.11-4.17）。相比之下，覆盖均等化法律与处方供应天数增加 2.13 天（95%置信区间，0.19-4.07）相关，但并未显著增加平均药物持有率或药物依从性概率。
结论
州远程医疗支付均等化法律与更高的药物依从性显著相关，而覆盖均等化法律则不然。随着各州越来越多地采用远程医疗均等化法律，这些发现可能有助于政策制定者了解其对高血压管理的潜在影响。
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