Carolyn T Thorpe1, Heather Johnson2, Anna Legreid Dopp3, Joshua M Thorpe4, Katie Ronk5, Christine M Everett6, Mari Palta5, David A Mott7, Betty Chewning7, Loren Schleiden8, Maureen A Smith9. 1. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA 15240-1001, USA; Department of Pharmacy and Therapeutics, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15261, USA. Electronic address: ctthorpe@pitt.edu. 2. Department of Medicine, University of Wisconsin, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA. 3. Pharmacy Society of Wisconsin, 701 Heartland Trail, Madison, WI 53717, USA. 4. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA 15240-1001, USA; Department of Pharmacy and Therapeutics, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15261, USA. 5. Department of Population Health Sciences, University of Wisconsin, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA. 6. Department of Community and Family Medicine, Duke University Medical Center, 318 Hanes House, DUMC 2914, Durham, NC 27710, USA. 7. School of Pharmacy, University of Wisconsin, 777 Highland Drive, Madison, WI 53705, USA. 8. Department of Pharmacy and Therapeutics, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15261, USA. 9. Department of Population Health Sciences, University of Wisconsin, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA; Department of Family Medicine, University of Wisconsin, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA; Department of Surgery, University of Wisconsin, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
Abstract
BACKGROUND: Studies in integrated health systems suggest that patients often accumulate oversupplies of prescribed medications, which is associated with higher costs and hospitalization risk. However, predictors of oversupply are poorly understood, with no studies in Medicare Part D. OBJECTIVE: The aim of this study was to describe prevalence and predictors of oversupply of antidiabetic, antihypertensive, and antihyperlipidemic medications in adults with diabetes managed by a large, multidisciplinary, academic physician group and enrolled in Medicare Part D or a local private health plan. METHODS: This was a retrospective cohort study. Electronic health record data were linked to medical and pharmacy claims and enrollment data from Medicare and a local private payer for 2006-2008 to construct a patient-quarter dataset for patients managed by the physician group. Patients' quarterly refill adherence was calculated using ReComp, a continuous, multiple-interval measure of medication acquisition (CMA), and categorized as <0.80 = Undersupply, 0.80-1.20 = Appropriate Supply, >1.20 = Oversupply. We examined associations of baseline and time-varying predisposing, enabling, and medical need factors to quarterly supply using multinomial logistic regression. RESULTS: The sample included 2519 adults with diabetes. Relative to patients with private insurance, higher odds of oversupply were observed in patients aged <65 in Medicare (OR = 3.36, 95% CI = 1.61-6.99), patients 65+ in Medicare (OR = 2.51, 95% CI = 1.37-4.60), patients <65 in Medicare/Medicaid (OR = 4.55, 95% CI = 2.33-8.92), and patients 65+ in Medicare/Medicaid (OR = 5.73, 95% CI = 2.89-11.33). Other factors associated with higher odds of oversupply included any 90-day refills during the quarter, psychotic disorder diagnosis, and moderate versus tight glycemic control. CONCLUSIONS: Oversupply was less prevalent than in previous studies of integrated systems, but Medicare Part D enrollees had greater odds of oversupply than privately insured individuals. Future research should examine utilization management practices of Part D versus private health plans that may affect oversupply. Published by Elsevier Inc.
BACKGROUND: Studies in integrated health systems suggest that patients often accumulate oversupplies of prescribed medications, which is associated with higher costs and hospitalization risk. However, predictors of oversupply are poorly understood, with no studies in Medicare Part D. OBJECTIVE: The aim of this study was to describe prevalence and predictors of oversupply of antidiabetic, antihypertensive, and antihyperlipidemic medications in adults with diabetes managed by a large, multidisciplinary, academic physician group and enrolled in Medicare Part D or a local private health plan. METHODS: This was a retrospective cohort study. Electronic health record data were linked to medical and pharmacy claims and enrollment data from Medicare and a local private payer for 2006-2008 to construct a patient-quarter dataset for patients managed by the physician group. Patients' quarterly refill adherence was calculated using ReComp, a continuous, multiple-interval measure of medication acquisition (CMA), and categorized as <0.80 = Undersupply, 0.80-1.20 = Appropriate Supply, >1.20 = Oversupply. We examined associations of baseline and time-varying predisposing, enabling, and medical need factors to quarterly supply using multinomial logistic regression. RESULTS: The sample included 2519 adults with diabetes. Relative to patients with private insurance, higher odds of oversupply were observed in patients aged <65 in Medicare (OR = 3.36, 95% CI = 1.61-6.99), patients 65+ in Medicare (OR = 2.51, 95% CI = 1.37-4.60), patients <65 in Medicare/Medicaid (OR = 4.55, 95% CI = 2.33-8.92), and patients 65+ in Medicare/Medicaid (OR = 5.73, 95% CI = 2.89-11.33). Other factors associated with higher odds of oversupply included any 90-day refills during the quarter, psychotic disorder diagnosis, and moderate versus tight glycemic control. CONCLUSIONS: Oversupply was less prevalent than in previous studies of integrated systems, but Medicare Part D enrollees had greater odds of oversupply than privately insured individuals. Future research should examine utilization management practices of Part D versus private health plans that may affect oversupply. Published by Elsevier Inc.
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Authors: Carolyn T Thorpe; Walid F Gellad; Maria K Mor; John P Cashy; John R Pleis; Courtney H Van Houtven; Loren J Schleiden; Joseph T Hanlon; Joshua D Niznik; Ronald L Carico; Chester B Good; Joshua M Thorpe Journal: Health Serv Res Date: 2018-10-16 Impact factor: 3.734