Brianne L Olivieri-Mui1, Benjamin Koethe2, Becky Briesacher2. 1. The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts. 2. Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Massachusetts.
Abstract
OBJECTIVES: Our aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). Medicare Part A pays NHs a bundled skilled nursing rate that includes prescription drugs for up to 100 days, after which individuals are responsible for the costs. DESIGN: A cross-sectional study. SETTING: NHs. PARTICIPANTS: A total of 694 newly admitted long-stay (>100 d) NH residents with HIV. MEASUREMENTS: We used Minimum Dataset v.3.0, pharmacy dispensing data, NH provider surveys, and Medicare claims from 2011 to 2013. We assessed receipt of any HIV antiretrovirals or recommended combinations (ART), as defined by national care guidelines, and the source of payment. We identified predictors of antiretroviral use with risk-adjusted generalized estimating equation logistic models. RESULTS: All study persons living with HIV/AIDS in NHs had prescription drug coverage through Medicare's Part D program, and ART was 100% covered. However, only 63.9% received recommended ART, and 15.2% never received any antiretrovirals during their NH stay. The strongest predictor of not receiving antiretrovirals was the first 100 days of a long NH stay (odds ratio [OR] = .44; 95% confidence interval [CI] = .24-.80). The strongest predictor of receiving recommended ART was health acuity (OR = 1.51; 95% CI = 1.20-1.88). CONCLUSION: People living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers. J Am Geriatr Soc 68:777-782, 2020.
OBJECTIVES: Our aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). Medicare Part A pays NHs a bundled skilled nursing rate that includes prescription drugs for up to 100 days, after which individuals are responsible for the costs. DESIGN: A cross-sectional study. SETTING: NHs. PARTICIPANTS: A total of 694 newly admitted long-stay (>100 d) NH residents with HIV. MEASUREMENTS: We used Minimum Dataset v.3.0, pharmacy dispensing data, NH provider surveys, and Medicare claims from 2011 to 2013. We assessed receipt of any HIV antiretrovirals or recommended combinations (ART), as defined by national care guidelines, and the source of payment. We identified predictors of antiretroviral use with risk-adjusted generalized estimating equation logistic models. RESULTS: All study persons living with HIV/AIDS in NHs had prescription drug coverage through Medicare's Part D program, and ART was 100% covered. However, only 63.9% received recommended ART, and 15.2% never received any antiretrovirals during their NH stay. The strongest predictor of not receiving antiretrovirals was the first 100 days of a long NH stay (odds ratio [OR] = .44; 95% confidence interval [CI] = .24-.80). The strongest predictor of receiving recommended ART was health acuity (OR = 1.51; 95% CI = 1.20-1.88). CONCLUSION:People living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers. J Am Geriatr Soc 68:777-782, 2020.
Authors: David J Meyers; Ira B Wilson; Yoojin Lee; Shubing Cai; Susan C Miller; Momotazur Rahman Journal: J Am Geriatr Soc Date: 2019-08-29 Impact factor: 5.562
Authors: Brianne Olivieri-Mui; Jean McGuire; Sean Cahill; John Griffith; Becky Briesacher Journal: J Assoc Nurses AIDS Care Date: 2019 Jan-Feb Impact factor: 1.354
Authors: Nadya Belenky; Brian W Pence; Stephen R Cole; Stacie B Dusetzina; Andrew Edmonds; Jonathan Oberlander; Michael W Plankey; Adebola Adedimeji; Tracey E Wilson; Jennifer Cohen; Mardge H Cohen; Joel E Milam; Elizabeth T Golub; Adaora A Adimora Journal: Med Care Date: 2018-01 Impact factor: 3.178