Department of Pharmaceutical Sciences, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Eli Lilly & Company, Indianapolis, IN, USA.
Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, USA.
Res Social Adm Pharm. 2022 Apr;18(4):2634-2642. doi: 10.1016/j.sapharm.2021.05.005. Epub 2021 May 11.
Low-income subsidy/dual eligibility (LIS/DE) status and disability status may be associated with high-risk medication (HRM) use but are not usually accounted for in medication-use quality measures.
To examine the association of: 1) LIS/DE status and HRM use; and 2) disability status and HRM use, while controlling for both health plan level effects and patient characteristics for Medicare beneficiaries enrolled in Medicare Advantage Prescription Drug Plans (MA-PD) and stand-alone Prescription Drug Plans (PDP).
This retrospective cross-sectional study used 2013 Medicare data to determine if LIS/DE status and disability status were independently associated with HRM use (using the Pharmacy Quality Alliance HRM measure) in MA-PDs and PDPs. Multivariable generalized linear mixed models assessed the association of LIS/DE and HRM use, and disability and HRM use, after adjusting for health plan effect and patient-level confounders for MA-PD and PDP beneficiaries.
Of 520,019 MA-PD beneficiaries, 88,693 (17.1%) were LIS/DE and 48,997 (9.4%) were disabled. Of 881,264 PDP beneficiaries, 213,096 (24.2%) were LIS/DE, and 83,593 (9.5%) were disabled. LIS/DE beneficiaries had a higher percent of HRM users compared to non-LIS/DE MA-PD (13.3% vs. 9.7%, p < 0.001) and PDP (17.1% vs. 13.2%, p < 0.001) beneficiaries. Disabled beneficiaries had a higher percent of HRM users compared to non-disabled MA-PD (17.0% vs. 9.6%, p < 0.001) and PDP (22.9% vs. 13.2%, p < 0.001) beneficiaries. Multivariable analyses showed LIS/DE (adjusted odds ratio [AOR] = 1.07; 95% CI = 1.04, 1.10) and disability (AOR = 1.38; 95% CI = 1.34, 1.42) were associated with HRM use among MA-PD and PDP beneficiaries (LIS/DE AOR = 1.14; 95% CI = 1.12, 1.16; disability AOR = 1.37; 95% CI = 1.34, 1.40).
The association of LIS/DE and disability with higher HRM use in both MA-PD and PDP beneficiaries, when controlling for health plan effects and patient characteristics, suggests these factors should be considered when comparing health plan performance on HRM measures.
低收入补贴/双重资格（LIS/DE）身份和残疾状况可能与高风险药物（HRM）的使用有关，但通常不在药物使用质量措施中考虑。
检验以下两者之间的关联：1）LIS/DE 身份和 HRM 使用；2）残疾状况和 HRM 使用，同时控制医疗保险优势处方药计划（MA-PD）和独立处方药计划（PDP）中健康计划水平的影响和患者特征。
本回顾性横断面研究使用 2013 年医疗保险数据，确定 LIS/DE 身份和残疾状况是否与 MA-PD 和 PDP 中的 HRM 使用（使用药房质量联盟 HRM 衡量标准）独立相关。多变量广义线性混合模型评估了 LIS/DE 和 HRM 使用以及残疾和 HRM 使用之间的关联，同时调整了 MA-PD 和 PDP 受益人的健康计划效果和患者水平混杂因素。
在 520019 名 MA-PD 受益人中，88693 人（17.1%）是 LIS/DE，48997 人（9.4%）是残疾。在 881264 名 PDP 受益人中，213096 人（24.2%）是 LIS/DE，83593 人（9.5%）是残疾。与非 LIS/DE MA-PD（13.3%对 9.7%，p<0.001）和 PDP（17.1%对 13.2%，p<0.001）相比，LIS/DE 受益人的 HRM 用户比例更高。与非残疾 MA-PD（17.0%对 9.6%，p<0.001）和 PDP（22.9%对 13.2%，p<0.001）相比，残疾受益人的 HRM 用户比例更高。多变量分析显示，LIS/DE（调整后的优势比[OR] = 1.07；95%置信区间[CI] = 1.04，1.10）和残疾（OR = 1.38；95%CI = 1.34，1.42）与 MA-PD 和 PDP 受益人的 HRM 使用相关（LIS/DE OR = 1.14；95%CI = 1.12，1.16；残疾 OR = 1.37；95%CI = 1.34，1.40）。
在控制健康计划效果和患者特征的情况下，LIS/DE 和残疾与 MA-PD 和 PDP 中更高的 HRM 使用之间的关联表明，在比较 HRM 措施的健康计划绩效时，应考虑这些因素。
