Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, 121 S. Main St, Box G-S121, Providence, RI 02912, USA.
J Gen Intern Med. 2013 Apr;28(4):546-53. doi: 10.1007/s11606-012-2244-9. Epub 2012 Nov 6.
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.
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.
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.
自 2005 年以来，医疗保险和医疗补助服务中心（CMS）要求所有医疗保险优势（MA）计划报告高危药物（HRM）的处方率。
确定全国 MA 参保者中，全国样本中符合全国质量保证委员会“老年人避免用药”质量指标的 HRM 接受情况的预测因素。
对 2009 年 415 个 MA 计划中 6204824 名 65 岁或以上年龄的参保者的医疗保健效果数据和信息集（HEDIS）数据进行回顾性分析。为了确定 HRM 使用的预测因素，我们拟合了广义线性模型，并在风险差异尺度上对结果进行了建模。
约 21%的 MA 参保者接受了至少一种 HRM，4.8%接受了至少两种 HRM。在完全调整的模型中，女性的接受率比男性高 10.6（95%置信区间：10.0-11.2），与新英格兰参考区相比，居住在美国南部任何一个地区的人的接受率都高出 10 个百分点以上。收入较低（6.5 个百分点，95%置信区间：5.5-7.5）的参保者的接受率也较高，与没有低收入的参保者和居住在社会经济地位最低五分位区（2.7 个百分点，95%置信区间：1.9-3.4）的参保者相比。85 岁以上的参保者、黑人参保者和其他少数族裔群体接受这些药物的可能性较低。居住在佐治亚州奥尔巴尼医院转诊区的 MA 参保者中，超过 38%的人接受了至少一种 HRM，这一比例是转诊率最低的梅森城（爱荷华州）的四倍。
MA 参保者中 HRM 的使用差异很大，地域差异显著。生活在美国南部地区、白人、女性以及收入和社会经济地位较低的人更有可能接受 HRM。
