Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN 38163, USA.
Res Social Adm Pharm. 2014 Jan-Feb;10(1):106-25. doi: 10.1016/j.sapharm.2013.03.007. Epub 2013 Jun 10.
Previous studies have found that racial and ethnic minorities would be less likely to meet the Medicare eligibility criteria for medication therapy management (MTM) services than their non-Hispanic White counterparts.
To examine whether racial and ethnic disparities in health status, health services utilization and costs, and medication utilization patterns among MTM-ineligible individuals differed from MTM-eligible individuals.
This study analyzed Medicare beneficiaries in 2004-2005 Medicare Current Beneficiary Survey. Various multivariate regressions were employed depending on the nature of dependent variables. Interaction terms between the dummy variables for Blacks (and Hispanics) and MTM eligibility were included to test whether disparity patterns varied between MTM-ineligible and MTM-eligible individuals. Main and sensitivity analyses were conducted for MTM eligibility thresholds for 2006 and 2010.
Based on the main analysis for 2006 MTM eligibility criteria, the proportions for self-reported good health status for Whites and Blacks were 82.82% vs. 70.75%, respectively (difference = 12.07%; P < 0.001), among MTM-ineligible population; and 56.98% vs. 52.14%, respectively (difference = 4.84%; P = 0.31), among MTM-eligible population. The difference between these differences was 7.23% (P < 0.001). In the adjusted logistic regression, the interaction effect for Blacks and MTM eligibility had an OR of 1.57 (95% Confidence Interval, or CI = 0.98-2.52) on multiplicative term and difference in odds of 2.38 (95% CI = 1.54-3.22) on additive term. Analyses for disparities between Whites and Hispanics found similar disparity patterns. All analyses for 2006 and 2010 eligibility criteria generally reported similar patterns. Analyses of other measures did not find greater racial or ethnic disparities among the MTM-ineligible than MTM-eligible individuals.
Disparities in MTM eligibility may aggravate existing racial and ethnic disparities in health outcomes. However, disparities in MTM eligibility may not aggravate existing disparities in health services utilization and costs and medication utilization patterns. Future studies should examine the effects of Medicare Part D on these disparities.
先前的研究发现，与非西班牙裔白人相比，少数族裔和少数民族不太可能符合医疗保险药物治疗管理（MTM）服务的资格标准。
检查 MTM 不合格人群与 MTM 合格人群之间在健康状况、卫生服务利用和费用以及药物利用模式方面的种族和民族差异是否存在差异。
本研究分析了 2004-2005 年医疗保险当前受益人大调查中的医疗保险受益人。根据因变量的性质，采用了各种多元回归。纳入黑人（和西班牙裔）和 MTM 资格的虚拟变量之间的交互项，以检验在 MTM 不合格和 MTM 合格人群之间，差异模式是否存在差异。对 2006 年和 2010 年的 MTM 资格标准进行了主要和敏感性分析。
根据 2006 年 MTM 资格标准的主要分析，白人报告健康状况良好的比例为 82.82%，黑人报告健康状况良好的比例为 70.75%（差异为 12.07%；P<0.001），在 MTM 不合格人群中；而在 MTM 合格人群中，这一比例分别为 56.98%和 52.14%（差异为 4.84%；P=0.31）。两者之间的差异为 7.23%（P<0.001）。在调整后的逻辑回归中，黑人与 MTM 资格之间的交互效应在乘法项上的比值比为 1.57（95%置信区间，或 CI=0.98-2.52），在加法项上的差异比为 2.38（95% CI=1.54-3.22）。对白人西班牙裔之间差异的分析发现了类似的差异模式。2006 年和 2010 年资格标准的所有分析通常报告了类似的模式。对其他措施的分析没有发现 MTM 不合格人群比 MTM 合格人群的种族或民族差异更大。
MTM 资格的差异可能会加剧现有的健康结果方面的种族和民族差异。然而，MTM 资格的差异可能不会加剧卫生服务利用和费用以及药物利用模式方面的现有差异。未来的研究应该检查医疗保险 D 部分对这些差异的影响。
