How disease burden influences medication patterns for Medicare beneficiaries: implications for policy

ArticleinCommonwealth Fund Issue Briefs 30:1-12 · March 2008with4 Reads
Source: PubMed
This issue brief provides benchmarks, based on empirical analyses of 2002 data, for evaluating the quality of pharmaceutical care under the Medicare Part D prescription drug benefit. The analyses cover all major classes of pharmaceuticals used by beneficiaries with one of eight chronic conditions. Common patterns observed include: 1) a mounting disease burden is associated with increasingly complex medication regimens in every group, and 2) the intensity and persistence of drug use tend to rise with disease burden up to a point, before declining for beneficiaries with the greatest morbidity. The study concludes that neither traditional drug quality indicators nor new quality assurance mechanisms mandated by law are well aligned to capture suboptimal medication use at either end of the spectrum of disease burden in the Medicare population. A holistic approach to medication management is needed to ensure that Part D plans meet beneficiaries and policymakers' expectations for high-quality care.
  • [Show abstract] [Hide abstract] ABSTRACT: Medicare Part D beneficiaries who reach the drug benefit threshold (DBT) risk adverse health outcomes. We explore clinical characteristics of beneficiaries who repeatedly reach the DBT during the first 2 years of Medicare Part D and may benefit from proactive identification for medication and care management. Retrospective cohort. 25,320 Medicare Advantage beneficiaries of whom 536 reached the DBT in 2006 only, ("2006 only"); 961 reached the DBT in 2006 and 2007 ("both years"); and 23,823 in neither year. We assessed repeatedly reaching the DBT (relative to 2006 only) as a function of demographics, morbidity (specific conditions and overall burden), medication use (specific classes and overall burden), utilization, and use of catastrophic and/or additional pharmacy benefits. Those who reached the DBT in both years had higher morbidity and utilization. In multivariate analyses, they were more likely than the 2006 only group to have one or more of 5 conditions (chronic pulmonary disease, dementia, depression, incontinence, and Parkinson disease), and within these conditions were more likely to use categories of trade-name medications for which there are limited available generic alternatives. Repeatedly reaching the DBT is a function of the extent and chronicity of disease burden and is characterized by conditions for which there is limited availability of generic medications, and associated common comorbidities. If these findings are confirmed, strategies at practice and policy levels may help such Medicare beneficiaries avoid unnecessary out of pocket expenditures on medications from prematurely reaching the DBT.
    Article · Mar 2010
  • [Show abstract] [Hide abstract] ABSTRACT: Employer-based retiree drug benefits have long been viewed as the gold standard of drug coverage for elderly Medicare beneficiaries. The question for policy makers is whether beneficiaries enrolled in Part D plans exhibit drug utilization patterns comparable with those seen in retiree plans. To compare utilization patterns for antidiabetic agents, renin-angiotensin-aldosterone system inhibitors, and antihyperlipidemics by elderly Medicare beneficiaries with diabetes enrolled in Medicare prescription drug plans (PDPs) and retiree health plans (RHPs). A random 5% sample (N=45,613) of elderly diabetic patients with continuous 2006 PDP enrollment was selected from Medicare files and compared with a similar sample of elderly RHP enrollees from MarketScan (N=211,919) on any use, duration of therapy, and medication possession ratio for each drug class. Adjusted comparisons were made on samples (N=16,859 each) using propensity score matching. Drug utilization and adherence rates were high in both groups. In propensity score adjusted comparisons, prevalence rates for PDP enrollees were within 2.2% of the level of RHP enrollees for antidiabetic agents and renin-angiotensin-aldosterone system inhibitors, but differed sharply for antihyperlipidemics (61% vs. 69%; P<0.0001). There were no clinically meaningful differences between PDP and RHP enrollees in duration of therapy or medication possession ratio for any drug class. When otherwise similar Medicare beneficiaries with diabetes have drug coverage, the source of benefits has little effect on use and adherence with most (but not all) drugs recommended in diabetes guidelines.
    Article · Mar 2011
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: The aim of this review is to consider how new knowledge on the genomic causes of disease can be used to determine which diet, life-style, environmental and psycho-social strategies are likely to provide better outcomes for disease prevention and well-being. Methods: Current evidence on the impact of nutrition, life-style, environmental and psycho-social factors on health and genome integrity was reviewed. Results: It is evident that nutrition plays an important role in prevention of genome pathology by providing the cofactors and molecules required for DNA synthesis, DNA repair and control of gene expression. However, loss of genome integrity with age is not only influenced by malnutrition but also exposure to environmental genotoxins, poor life-style choices and adverse psycho-social environments. A holistic approach that integrates knowledge of genetic susceptibility with all of the above risk factors is required to efficiently prevent loss of DNA integrity which is the fundamental cause of developmental and degenerative diseases. Conclusion: A comprehensive public health policy aimed at improving DNA integrity levels in populations should be implemented world-wide by increasing access to foods rich in genome-protective micronutrients, minimising exposure to environmental genotoxins and promotion of life-style habits and psycho-social environments associated with improved genome stability. A revised Hippocratic oath is proposed to guide new education strategies required to train health professionals how to deliver optimal public health outcomes at the fundamental genomic level.
    Full-text · Article · Mar 2013 · Medical care
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