Chu Lily, Schnelle John F, Osterweil Dan
Department of Medicine, Division of Geriatrics, University of California at Los, Los Angeles School of Medicine, Los Angeles, CA 91335, USA.
J Am Med Dir Assoc. 2004 Mar-Apr;5(2):75-81. doi: 10.1097/01.JAM.0000113429.87302.2E.
The objectives of this study were to describe changes in prescription analgesic and antidepressant medications and to track the costs associated with these medication changes when elderly Medicaid beneficiaries move from the community to a nursing home setting.
Retrospective analysis of Medicaid long-term care and drugs claims data for fiscal year 2000 from three different states.
Long-term care facilities in three different states.
We studied 1321 elderly Medicaid beneficiaries newly admitted to a nursing home during the study period.
Pain medications were grouped into four different categories and all antidepressants were grouped into one category. For each medication category, we obtained the number of unique patients for whom it was prescribed, the number of days it was prescribed, and the amount paid by Medicaid. We then calculated the percentage of subjects prescribed and the amount paid per day for each medication class before and after nursing home admission.
Except for skeletal muscle relaxants, 21% to 39% of beneficiaries already had claims linked to each medication class while still living in the community. After nursing home admission, the percentage of beneficiaries exposed to each medication class increased by 2% to 33%. Cost per day of therapy increased by 10% to 83%. There was significant variation among the states in utilization and cost per day of therapy.
We draw three major conclusions: (1) community-dwelling elderly Medicaid beneficiaries in this study use more prescription analgesics and antidepressants than community-dwelling elders in prior studies; (2) there is a significant increase in medication utilization and cost on nursing home admission; and (3) significant variability in medication use and cost exists among the three states examined. Further investigation to elucidate the reasons for these differences could assist legislators in formulating sound public policy to contain Medicaid expenditures without sacrificing patient care.
本研究的目的是描述处方镇痛药和抗抑郁药的变化情况，并追踪老年医疗补助受益人群从社区转入疗养院时与这些药物变化相关的费用。
对来自三个不同州的2000财年医疗补助长期护理和药品报销数据进行回顾性分析。
三个不同州的长期护理机构。
我们研究了在研究期间新入住疗养院的1321名老年医疗补助受益人。
将止痛药分为四类，所有抗抑郁药归为一类。对于每类药物，我们获取了开具该药物的独特患者数量、开具天数以及医疗补助支付的金额。然后，我们计算了入住疗养院前后每类药物的处方开具受试者百分比和每日支付金额。
除骨骼肌松弛剂外，21%至39%的受益人在仍居住在社区时就已有与各类药物相关的报销记录。入住疗养院后，接触各类药物的受益人百分比增加了2%至33%。每日治疗费用增加了10%至83%。各州在治疗的利用率和每日费用方面存在显著差异。
我们得出三个主要结论：（1）本研究中居住在社区的老年医疗补助受益人比先前研究中的社区老年人使用更多的处方镇痛药和抗抑郁药；（2）入住疗养院后药物利用率和费用显著增加；（3）在所研究的三个州中，药物使用和费用存在显著差异。进一步调查以阐明这些差异的原因，有助于立法者制定合理的公共政策，在不牺牲患者护理的情况下控制医疗补助支出。
