Dong Xiaobei, Tsang Chi Chun Steve, Browning Jamie A, Garuccio Joseph, Wan Jim Y, Shih Ya Chen Tina, Chisholm-Burns Marie A, Dagogo-Jack Samuel, Cushman William C, Wang Junling, Wang Junling
Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th St., Milwaukee, WI 53205, United States of America.
Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 212, Memphis, TN 38163, United States of America.
Explor Res Clin Soc Pharm. 2023 Jan 11;9:100222. doi: 10.1016/j.rcsop.2023.100222. eCollection 2023 Mar.
The Medicare Part D medication therapy management (MTM) program has positive effects on medication and health service utilization. However, little is known about its utilization, much less so about the use among racial and ethnic minorities.
To examine MTM service utilization among older Medicare beneficiaries and to identify any racial and ethnic disparity patterns.
A retrospective cross-sectional analysis of 2017 Medicare administrative data, linked to the Area Health Resources Files. Fourteen outcomes related to MTM service nature, initiation, quantity, and delivery were examined using logistic, negative binomial, and Cox proportional hazards regression models.
Racial and ethnic disparities were found with varying patterns across outcomes. For example, compared with White patients, the odds of opting out of MTM were 8% higher for Black patients (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.03-1.14), 57% higher for Hispanic patients (OR = 1.57, 95% CI = 1.42-1.72), and 57% higher for Asian patients (OR = 1.57, 95% CI = 1.33-1.85). The odds of continuing MTM from the previous years were 12% lower for Black patients (OR = 0.88, 95% CI = 0.86-0.90) and 3% lower for other patients (OR = 0.97, 95% CI = 0.95-0.99). In addition, the probability of being offered a comprehensive medication review (CMR) after MTM enrollment was 9% lower for Hispanic patients (hazard ratio [HR] = 0.91, 95% CI = 0.85-0.97), 9% lower for Asian patients (HR = 0.91, 95% CI = 0.87-0.94), and 3% lower for other patients (HR = 0.97, 95% CI = 0.95-0.99). Hispanic and Asian patients were more likely to have someone other than themselves receive a CMR.
Racial and ethnic disparities in MTM service utilization were identified. Although the disparities in specific utilization outcomes vary across racial/ethnic groups, it is evident that these disparities exist and may result in vulnerable communities not fully benefiting from the MTM services. Causes of the disparities should be explored to inform future reform of the Medicare Part D MTM program.
医疗保险D部分药物治疗管理（MTM）计划对药物使用和医疗服务利用具有积极影响。然而，对于该计划的利用情况知之甚少，对于少数种族和族裔群体中的使用情况更是了解不足。
研究老年医疗保险受益人的MTM服务利用情况，并确定是否存在任何种族和族裔差异模式。
对2017年医疗保险行政数据进行回顾性横断面分析，并与地区卫生资源文件相链接。使用逻辑回归、负二项回归和Cox比例风险回归模型，研究了与MTM服务性质、启动、数量和提供相关的14项结果。
发现不同结果存在不同模式的种族和族裔差异。例如，与白人患者相比，黑人患者选择退出MTM的几率高8%（比值比[OR]=1.08，95%置信区间[CI]=1.03-1.14），西班牙裔患者高57%（OR=1.57，95%CI=1.42-1.72），亚裔患者高57%（OR=1.57，95%CI=1.33-1.85）。黑人患者从前一年继续接受MTM的几率低12%（OR=0.88，95%CI=0.86-0.90），其他患者低3%（OR=0.97，95%CI=0.95-0.99）。此外，西班牙裔患者在参加MTM后接受全面药物审查（CMR）的概率低9%（风险比[HR]=0.91，95%CI=0.85-0.97），亚裔患者低9%（HR=0.91，95%CI=0.87-0.94），其他患者低3%（HR=0.97，95%CI=0.95-0.99）。西班牙裔和亚裔患者更有可能让他人接受CMR。
确定了MTM服务利用方面的种族和族裔差异。尽管特定利用结果的差异在不同种族/族裔群体中有所不同，但显然这些差异存在，可能导致弱势群体无法充分受益于MTM服务。应探索差异的原因，为未来医疗保险D部分MTM计划的改革提供参考。
