Department of Psychiatry, University of Michigan(LL, DTM).
Department of Internal Medicine, University of Michigan (JPWB); Institute for Healthcare Policy and Innovation, University of Michigan (JPWB, DTM).
Am J Geriatr Psychiatry. 2022 Feb;30(2):249-255. doi: 10.1016/j.jagp.2021.08.010. Epub 2021 Aug 28.
To examine whether prescription fills of opioids and central nervous system (CNS) depressants are lower in Medicare Advantage (MA) plans, which aim to provide more coordinated and integrated care, than fee-for-service (FFS) Medicare.
Data from the 2015 National Health and Aging Trends Study linked with Medicare claims. Community-dwelling adults ≥65 enrolled in Medicare Part D were included (n = 5,652). Prescription fills of opioids, antipsychotics, benzodiazepines, gabapentinoids, and co-prescriptions of opioids with the other medications in MA versus FFS Medicare were examined using multivariate logistic models. Propensity score weighting was applied to account for differences in characteristics between MA and FFS beneficiaries.
MA enrollees were less likely to fill prescriptions for benzodiazepines (15.6% versus 19.0%; marginal difference: -3.4%, t = -2.54, df = 56, p = 0.01), and co-prescriptions of opioids and gabapentinoids (5.1% versus 6.7%; marginal difference: -1.6%, t = -2.07, df = 56, p = 0.04) than FFS beneficiaries. There were no significant differences among the other prescription outcomes.
MA was associated with slightly lower likelihood of receiving opioids and some CNS depressants.
研究与按服务项目付费的医疗保险（fee-for-service Medicare，FFS Medicare）相比，旨在提供更协调和综合医疗服务的医疗保险优势计划（Medicare Advantage，MA）中开出的阿片类药物和中枢神经系统抑制剂（central nervous system depressants，CNS 抑制剂）处方是否较少。
从 2015 年国家健康老龄化趋势研究（National Health and Aging Trends Study）中获取的数据与医疗保险索赔数据相链接。纳入了参加医疗保险部分 D（Medicare Part D）的、居住在社区的 65 岁及以上成年人（n=5652）。使用多变量逻辑模型检查 MA 与 FFS Medicare 中开出的阿片类药物、抗精神病药、苯二氮䓬类药物、加巴喷丁类药物处方以及 MA 中阿片类药物与其他药物的联合处方情况。采用倾向评分加权法来考虑 MA 和 FFS 受益人的特征差异。
MA 参保者开具苯二氮䓬类药物（15.6% vs. 19.0%；边际差异：-3.4%，t=-2.54，df=56，p=0.01）和阿片类药物与加巴喷丁类药物联合处方（5.1% vs. 6.7%；边际差异：-1.6%，t=-2.07，df=56，p=0.04）的可能性低于 FFS 受益者。其他处方结果无显著差异。
MA 与较低可能性接受阿片类药物和一些 CNS 抑制剂相关。
