65岁以下医疗保险受益人中与精神药物处方、精神科住院治疗及支出相关的因素。

Factors associated with psychotropic prescriptions, psychiatric hospitalization, and spending among Medicare beneficiaries under 65.

作者信息

Qian Jingjing, Wittayanukorn Saranrat, McGuffey Grant, Hansen Richard

机构信息

Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, AL 36849, USA.

出版信息

Disabil Health J. 2015 Jul;8(3):424-33. doi: 10.1016/j.dhjo.2015.03.005. Epub 2015 Mar 14.

DOI:10.1016/j.dhjo.2015.03.005

PMID:25890881

Abstract

BACKGROUND

Medicare beneficiaries under 65 are a medically heterogenous population with significant psychiatric health service utilization. Patterns of psychiatric health services utilization and spending have not been well studied in this population.

OBJECTIVE

To estimate and compare annual trends in psychotropic prescriptions, psychiatric hospitalization, and total Medicare spending between Medicare beneficiaries <65 and those ≥ 65. We also identified factors associated with these outcomes among Medicare beneficiaries under 65.

METHODS

This serial cross-sectional study used 2006-2009 Medicare Current Beneficiary Survey (MCBS) data linked with Medicare claims. Psychotropic prescription and psychiatric hospitalization were measured using claims data. Total annual Medicare spending included reimbursements from Medicare Parts A, B, and D. Repeated person-year data were analyzed using generalized estimating equation (GEE) models to examine associations between factors and outcomes among beneficiaries <65, controlling for covariates.

RESULTS

Over one-third of beneficiaries <65 used at least one psychotropic prescription annually. Annual prevalence of psychotropic prescription and psychiatric hospitalization was higher among beneficiaries <65 than those ≥ 65 (threefold and ten-fold, respectively), as well as Medicare spending. The annual prevalence of psychiatric hospitalization decreased over time among beneficiaries <65. Antidepressants were the most prevalently prescribed psychotropic drug class among beneficiaries <65. Factors associated with psychiatric services utilization and spending among beneficiaries <65 included demographics and health insurance access, self-reported health, smoking status, and comorbidities (all P < 0.05).

CONCLUSIONS

Our findings highlight the special psychiatric health care needs of Medicare beneficiaries under 65 and call for the attention of policy makers and clinicians to this understudied population.

摘要

背景

65岁以下的医疗保险受益人是一个医疗情况各异的群体，他们对精神健康服务的利用率很高。该群体的精神健康服务利用模式和支出情况尚未得到充分研究。

目的

估计并比较65岁以下和65岁及以上医疗保险受益人的精神类药物处方、精神科住院治疗及医疗保险总支出的年度趋势。我们还确定了65岁以下医疗保险受益人中与这些结果相关的因素。

方法

这项系列横断面研究使用了2006 - 2009年医疗保险当前受益人调查（MCBS）数据与医疗保险理赔数据相链接。使用理赔数据来衡量精神类药物处方和精神科住院治疗情况。年度医疗保险总支出包括医疗保险A、B和D部分的报销费用。使用广义估计方程（GEE）模型分析重复的人年数据，以检验65岁以下受益人中各因素与结果之间的关联，并对协变量进行控制。

结果

超过三分之一的65岁以下受益人每年至少使用一种精神类药物处方。65岁以下受益人中精神类药物处方和精神科住院治疗的年度患病率高于65岁及以上的受益人（分别高出三倍和十倍），医疗保险支出也是如此。65岁以下受益人中精神科住院治疗的年度患病率随时间下降。抗抑郁药是65岁以下受益人中最常开具的精神类药物类别。65岁以下受益人中与精神科服务利用和支出相关的因素包括人口统计学特征、医疗保险覆盖情况、自我报告的健康状况、吸烟状况和合并症（所有P < 0.05）。