药物治疗管理资格标准在不同种族/族裔群体中的比较效果。
Comparative Effectiveness of Medication Therapy Management Eligibility Criteria Across Racial/Ethnic Groups.
机构信息
Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, Memphis, Tennessee.
Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, Memphis, Tennessee.
出版信息
J Am Geriatr Soc. 2019 Mar;67(3):581-587. doi: 10.1111/jgs.15754. Epub 2019 Jan 23.
BACKGROUND/OBJECTIVES: Previous research indicates that eligibility criteria for medication therapy management (MTM) services in Medicare prescription drug (Part D) plans, defined under the Medicare Modernization Act (MMA), are associated with racial/ethnic disparities and ineffective in identifying individuals with medication utilization issues. Our study's objective was to determine the comparative effectiveness of MTM eligibility criteria under MMA and in the Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial/ethnic groups.
DESIGN
ACA and MMA MTM eligibility criteria were compared on proportions of eligible individuals among patients with medication utilization issues. Multinomial logistic regression was conducted to control for patient/community characteristics. Need-based and demand-based analyses were used to determine disparities due to need and demand for healthcare. Main/sensitivity analyses were conducted for the range of eligibility thresholds.
SETTING
Medicare data (2012-2013) linked to Area Health Resources Files.
PARTICIPANTS
A total of 964 610 patients 65 years or older.
MEASUREMENTS
Medication safety/adherence measures, developed primarily by the Pharmacy Quality Alliance, were used to determine medication utilization issues.
RESULTS
Higher proportions of patients were eligible based on ACA than MMA MTM eligibility criteria. For example, in 2013, proportions based on ACA and MMA MTM eligibility criteria would be 99.7% and 26.2%, respectively, in the main analysis (p < .001); in the demand-based main analysis, ACA criteria were associated with 13.6% and 9.8%, respectively, higher effectiveness than MMA criteria among non-Hispanic blacks and Hispanics than non-Hispanic whites.
CONCLUSION
ACA MTM eligibility criteria are more effective than MMA criteria in identifying older patients needing MTM, particularly among minorities. J Am Geriatr Soc 67:581-587, 2019.
背景/目的：先前的研究表明，医疗保险处方药（Part D）计划中的药物治疗管理（MTM）服务资格标准（根据《医疗保险现代化法案》（MMA）定义）与种族/族裔差异有关，并且无法有效识别存在用药问题的个体。我们的研究目的是确定《平价医疗法案》（ACA）和《医疗保险现代化法案》（MMA）中的 MTM 资格标准在识别各族裔用药问题患者方面的相对有效性。
设计
根据有用药问题的患者中符合资格的个体比例，对 ACA 和 MMA 的 MTM 资格标准进行了比较。采用多项逻辑回归来控制患者/社区特征。采用基于需求和基于需求的分析来确定由于对医疗保健的需求和需求而产生的差异。主要/敏感性分析是针对资格标准的范围进行的。
设置
医疗保险数据（2012-2013 年）与区域卫生资源档案相关联。
参与者
共有 964610 名 65 岁或以上的患者。
测量
主要由药房质量联盟制定的药物安全/依从性措施用于确定药物使用问题。
结果
根据 ACA，比 MMA MTM 资格标准，更多的患者符合资格。例如，在主要分析中，2013 年，基于 ACA 和 MMA MTM 资格标准的比例将分别为 99.7%和 26.2%（p<0.001）；在基于需求的主要分析中，非西班牙裔黑人和西班牙裔患者的 ACA 标准分别比 MMA 标准高 13.6%和 9.8%，在非西班牙裔白人患者中，与 MTM 标准相比，识别出需要 MTM 的老年患者更有效。
结论
与 MMA 标准相比，ACA MTM 资格标准在识别需要 MTM 的老年患者方面更有效，特别是在少数民族中。J Am Geriatr Soc 67:581-587, 2019.
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