Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Since 2005, the Centers for Medicare and Medicaid Services (CMS) has required all Medicare Advantage (MA) plans to report prescribing rates of high risk medications (HRM).
To determine predictors of receipt of HRMs, as defined by the National Committee for Quality Assurance’s “Drugs to Avoid in the Elderly” quality indicator, in a national sample of MA enrollees.
DESIGN AND PARTICIPANTS
Retrospective analysis of Healthcare Effectiveness Data and Information Set (HEDIS) data for 6,204,824 enrollees, aged 65 years or older, enrolled in 415 MA plans in 2009. To identify predictors of HRM use, we fit generalized linear models and modeled outcomes on the risk-difference scale.
MAIN OUTCOME MEASURES
Receipt or non-receipt of one or two HRMs.
Approximately 21 % of MA enrollees received at least one HRM and 4.8 % received at least two. 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).
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.
- Institute of Medicine (U.S.). Aspden P, Wolcott JA, Bootman JL, Cronenwett LR, Eds. Preventing Medication Errors. Committee on Identifying and Preventing Medication Errors. . Washington: National Academies Press; 2007.
- Hohl, CM, Zed, PJ, Brubacher, JR, Abu-Laban, RB, Loewen, PS, Purssell, RA (2010) Do emergency physicians attribute drug-related emergency department visits to medication-related problems?. Ann Emerg Med 55: pp. 493-502 CrossRef
- Hohl, CM, Dankoff, J, Colacone, A, Afilalo, M (2001) Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 38: pp. 666-671 CrossRef
- Bond, CA, Raehl, CL (2008) 2006 national clinical pharmacy services survey: clinical pharmacy services, collaborative drug management, medication errors, and pharmacy technology. Pharmacotherapy 28: pp. 1-13 CrossRef
- Gurwitz, JH, Field, TS, Avorn, J (2000) Incidence and preventability of adverse drug events in nursing homes. Am J Med 109: pp. 87-94 CrossRef
- Cahir, C, Fahey, T, Teeling, M, Teljeur, C, Feely, J, Bennett, K (2010) Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol 69: pp. 543-552 CrossRef
- Budnitz, DS, Shehab, N, Kegler, SR, Richards, CL (2007) Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 147: pp. 755-U726
- Fick, D, Semla, T, Beizer, J (2012) American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 60: pp. 616-631 CrossRef
- Zhan, C, Sangl, J, Bierman, AS (2001) Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA 286: pp. 2823-2829 CrossRef
- Lichtenberg, FR, Sun, SX (2007) The impact of medicare part D on prescription drug use by the elderly. Health Aff 26: pp. 1735-1744 CrossRef
- Fu, AZ, Tang, AS, Wang, N, Du, DT, Jiang, JZ (2010) Effect of Medicare Part D on potentially inappropriate medication use by older adults. J Am Geriatr Soc 58: pp. 944-949 CrossRef
- Riley, G, Zarabozo, C (2006) Trends in the health status of medicare risk contract enrollees. Health Care Financ Rev. Winter 28: pp. 81-95
- Stockl, KM, Le, L, Zhang, S, Harada, AS (2010) Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care. 16: pp. e1-10
- Chrischilles, EA, VanGilder, R, Wright, K, Kelly, M, Wallace, RB (2009) Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc 57: pp. 1000-1006 CrossRef
- Berdot, S, Bertrand, M, Dartigues, JF, Fourrier, A, Tavernier, B, Ritchie, K (2009) Inappropriate medication use and risk of falls—a prospective study in a large community-dwelling elderly cohort. BMC Geriatr 9: pp. 30 CrossRef
- Use of high-risk medications in the elderly: Percentage of Medicare members 65 years of age and older who received at least one high-risk medication. Available at: http://www.qualitymeasures.ahrq.gov/content.aspx?id=34685. Accessed September 25, 2012.
- Pugh, MJV, Hanlon, JT, Zeber, JE, Bierman, A, Cornell, J, Berlowitz, DR (2006) Assessing potentially inappropriate prescribing in the elderly veterans affairs population using the HEDIS 2006 quality measure. J Manag Care Pharm. 12: pp. 537-545
- The Dartmouth atlas of health care, 1999. Chicago Ill.: American Hospital Publishing; 1999.
- Landon, BE, Keating, NL, Barnett, ML (2012) Variation in patient-sharing networks of physicians across the United States. JAMA 308: pp. 265-273 CrossRef
- Zhang, Y, Baicker, K, Newhouse, JP (2010) Geographic variation in the quality of prescribing. N Engl J Med 363: pp. 1985-1988 CrossRef
- Baicker K, Chandra A, Skinner JS, Wennberg JE. Who you are and where you live: how race and geography affect the treatment of medicare beneficiaries. Health Aff. 2004;Suppl Variation:VAR33-44.
- Koroukian, SM, Dahman, B, Copeland, G, Bradley, CJ (2010) The utility of the state buy-in variable in the Medicare denominator file to identify dually eligible Medicare-Medicaid beneficiaries: a validation study. Health Serv Res. 45: pp. 265-282 CrossRef
- Agency for Healthcare Research and Quality. Creation of new race-ethnicity codes and socioeconomic status (SES) indicators for medicare beneficiaries. Available at: http://www.ahrq.gov/qual/medicareindicators. Accessed September 25, 2012.
- Yang, HWK, Simoni-Wastila, L, Zuckerman, IH, Stuart, B (2008) Benzodiazepine use and expenditures for Medicare beneficiaries and the implications of Medicare Part D exclusions. Psychiatr Serv 59: pp. 384-391 CrossRef
- Goulding, MR (2004) Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med 164: pp. 305-312 CrossRef
- Morabia, A, Fabre, J, Dunand, JP (1992) The influence of patient and physician gender on prescription of psychotropic drugs. J Clin Epidemiol. 45: pp. 111-116 CrossRef
- Simoni-Wastila, L (1998) Gender and psychotropic drug use. Med Care 36: pp. 88-94 CrossRef
- Bierman, AS, Pugh, MJ, Dhalla, I (2007) Sex differences in inappropriate prescribing among elderly veterans. Am J Geriatr Pharmacother 5: pp. 147-161 CrossRef
- Bao, Y, Alexopoulos, GS, Casalino, LP (2011) Collaborative depression care management and disparities in depression treatment and outcomes. Arch Gen Psychiatr 68: pp. 627-636 CrossRef
- Alegria, M, Chatterji, P, Wells, K (2008) Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States. Psychiatr Serv 59: pp. 1264-1272 CrossRef
- Keyes, KM, Hatzenbuehler, ML, Alberti, P, Narrow, WE, Grant, BF, Hasin, DS (2008) Service utilization differences for Axis I psychiatric and substance use disorders between white and black adults. Psychiatr Serv 59: pp. 893-901 CrossRef
- Rosenthal, T (2012) Geographic variation in health care. Annu Rev Med 63: pp. 493-509 CrossRef
- Maps of Diagnosed Diabetes and Obesity in 1994, 2000, and 2010 2011. Available at: http://www.cdc.gov/diabetes/statistics/slides/maps_diabetesobesity94.pdf. Accessed September 25, 2012.
- Ogden, CL, Flegal, KM (2012) Prescription Medication Use Among Normal Weight, Overweight, and Obese Adults, United States, 2005–2008. Ann Epidemiol 22: pp. 8p
- Zhang, YJ, Liu, WW, Wang, JB, Guo, JJ (2011) Potentially inappropriate medication use among older adults in the USA in 2007. Age Ageing 40: pp. 398-401 CrossRef
- Wang, YR, Pauly, MV (2005) Spillover effects of restrictive drug formularies on physician prescribing behavior: Evidence from Medicaid. J Econ Manage Strat Fal 14: pp. 755-773 CrossRef
- Joyce, GF, Escarce, JJ, Solomon, MD, Goldman, DP (2002) Employer drug benefit plans and spending on prescription drugs. JAMA 288: pp. 1733-1739 CrossRef
- Fu, AZ, Liu, GG, Christensen, DB (2004) Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc 52: pp. 1934-1939 CrossRef
- Bao, YH, Shao, HB, Bishop, TF, Schackman, BR, Bruce, ML (2012) Inappropriate Medication in a National Sample of US Elderly Patients Receiving Home Health Care. J Gen Intern Med 27: pp. 304-310 CrossRef
- Garcia-Gollarte F, Baleriola-Julvez J, Ferrero-Lopez I, Cruz-Jentoft AJ. Inappropriate Drug Prescription at Nursing Home Admission. J Am Med Dir Assoc. Jan 2012;13(1).
- Parsons, C, Johnston, S, Mathie, E (2012) Potentially Inappropriate Prescribing in Older People with Dementia in Care Homes A Retrospective Analysis. Drugs Aging 29: pp. 143-155 CrossRef
- Ryan, C, O’Mahony, D, Kennedy, J, Weedle, P, Byrne, S (2009) Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol 68: pp. 936-947 CrossRef
- National Committee for Quality Assurance. Continuous improvement and the expansion of quality improvement: The state of health care quality 2011. Available at: http://www.ncqa.org/LinkClick.aspx?fileticket=J8kEuhuPqxk%3d&tabid=836. Accessed September 25, 2012.
- Garfinkel, D, Mangin, D (2010) Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med 170: pp. 1648-1654 CrossRef
- PL Detail-Document, Potentially Harmful Drugs in the Elderly: Beers List. Pharmacist’s Letter/Prescriber’s Letter. Document # 280610. Available at: http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=&s=PL&pt=2&segment=4413&dd=280610. Accessed September 25, 2012.
- Avorn, J (2001) Improving drug use in elderly patients: getting to the next level. JAMA 286: pp. 2866-2868 CrossRef
- Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans
Journal of General Internal Medicine
Volume 28, Issue 4 , pp 546-553
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- high risk medications
- geriatric prescribing
- potentially inappropriate medication
- quality prescribing
- Industry Sectors
- Author Affiliations
- 1. Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, 121 S. Main St, Box G-S121, Providence, RI, 02912, USA
- 2. Research Enhancement Award Program, Providence VA Medical Center, Providence, RI, USA