Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

Abstract

In fully adjusted models, females had a 10.6 (95 % CI: 10.0-11.2) higher percentage point rate of receipt than males, and residence in any of the Southern United States divisions was associated with a greater than 10 percentage point higher rate, as compared with the reference New England division. Higher rates were also observed among enrollees with low personal income (6.5 percentage points, 95 % CI: 5.5-7.5), relative to those without low income and those residing in areas in the lowest quintile of socioeconomic status (2.7 points, 95 % CI: 1.9-3.4) relative to persons residing in the highest quintile. Enrollees ≥ 85 years old, black enrollees, and other minority groups were less likely to receive these medications. Over 38 % of MA enrollees residing in the hospital referral region of Albany, Georgia received at least one HRM, a rate four times higher than the referral region with the lowest rate (Mason City, Iowa). CONCLUSIONS: Use of HRMs among MA enrollees varies widely by geographic region. Persons living in the Southern region of the U.S., whites, women, and persons of low personal income and socioeconomic status are more likely to receive HRMs.

Potentially Inappropriate Anticholinergic Medication Use in Community-Dwelling Older Adults: A National Cross-Sectional Study

“…This suggests that there is a variation in potentially inappropriate anticholinergic use due to geographic region. Previous studies have suggested that regional variation exists in prescribing of medications included in the Beer's Criteria, and they found that Medicare beneficiaries residing in the South were more likely to receive high-risk medications than their counterparts residing in the Northeast [41,42]. The observed finding in the current study with respect to regional variation in potentially inappropriate anticholinergic medication use can be attributed to differences in prescribing practices, patient preferences, or formulary structure across geographic regions.…”

Geographic Variation in Medication Adherence in Commercial and Medicare Part D Populations

“…[10][11][12] In a recent publication, Qato and Trivedi (2013) highlighted the geographic disparities in high-risk medication utilization in the elderly population in the United States. 13 This publication has heightened awareness of the significant variation that can exist when looking at a widely used quality metric across geographic regions. In another recent publication on statin adherence, using data from 2006-2007 prescription claims, Franklin et al (2013) showed that the adherent populations were more likely to be older, to have a higher income, and to live in the New England region.…”

Ageism in Medication Use in Older Patients

“…Zhan et al (2001) discussed, based on their findings, that visits at physicians' offices may frequently end with drug prescription in order to satisfy the patient. Some studies also showed that if older patients were more dependent on the prescriber (e.g., when they suffered from psychiatric illness, were in a poor economic situation, or did not have a partner) they were at significantly higher risk of inappropriate prescribing (Baldoni et al 2014;Fialová et al 2005;Qato and Trivedi 2013;Vieira de Lima et al 2013). These examples suggest ageist behaviour, even though ageism has not yet been thoroughly studied in relation to prescribing practices.…”