Garuccio Joseph, Tsang Chi Chun Steve, Wan Jim Y, Shih Ya Chen Tina, Chisholm-Burns Marie A, Dagogo-Jack Samuel, Cushman William C, Dong Xiaobei, Browning Jamie A, Zeng Rose, Wang Junling
Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA.
Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, USA.
J Pharm Health Serv Res. 2023 Mar 30;14(2):188-197. doi: 10.1093/jphsr/rmad010. eCollection 2023 Jun.
Racial/ethnic disparities have been found in prior literature examining enrolment in Medicare medication therapy management programs. However, those studies were based on various eligibility scenarios because enrolment data were unavailable. This study tested for potential disparities in enrolment using actual MTM enrolment data.
Medicare Parts A&B claims, Medication Therapy Management Data Files, and the Area Health Resources File from 2013 to 2014 and 2016 to 2017 were analysed in this retrospective analysis. An adjusted logistic regression compared odds of enrolment between racial/ethnic minorities and non-Hispanic Whites (Whites) in the total sample and subpopulations with diabetes, hypertension, or hyperlipidaemia. Trends in disparities were analysed by including interaction terms in regressions between dummy variables for race/ethnic minority groups and period 2016-2017.
Disparities in MTM enrolment were detected between Blacks and Whites with diabetes in 2013-2014 (Odds Ratio = 0.78, 95% Confidence Interval = 0.75-0.81). This disparity improved from 2013-2014 to 2016-2017 for Blacks (Odds Ratio=1.08, 95% Confidence Interval = 1.04-1.11) but persisted in 2016-2017 (Odds Ratio = 0.84, 95% Confidence Interval = 0.81-0.87). A disparity was identified between Blacks and Whites with hypertension in 2013-2014 (Odds Ratio = 0.92, 95% Confidence Interval = 0.89-0.95) but not in 2016-2017. Enrolment for all groups, however, declined between periods. For example, in the total sample, the odds of enrolment declined from 2013-2014 to 2016-2017 by 22% (Odds Ratio=0.78, 95% Confidence Interval=0.75-0.81).
Racial disparities in MTM enrolment were found between Blacks and Whites among Medicare beneficiaries with diabetes in both periods and among individuals with hypertension in 2013-2014. As overall enrolment fell between periods, concerns about program enrolment remain.
在先前有关医疗保险药物治疗管理项目参保情况的文献中发现了种族/族裔差异。然而，由于无法获取参保数据，这些研究基于各种资格认定情况。本研究使用实际的药物治疗管理参保数据测试参保方面的潜在差异。
在这项回顾性分析中，对2013年至2014年以及2016年至2017年的医疗保险A部分和B部分索赔数据、药物治疗管理数据文件以及地区卫生资源文件进行了分析。采用调整后的逻辑回归比较了总样本以及患有糖尿病、高血压或高脂血症的亚人群中种族/族裔少数群体与非西班牙裔白人（白人）的参保几率。通过在种族/族裔少数群体的虚拟变量与2016 - 2017年期间的回归中纳入交互项来分析差异趋势。
2013 - 2014年，患有糖尿病的黑人和白人在药物治疗管理参保方面存在差异（比值比 = 0.78，95%置信区间 = 0.75 - 0.81）。从2013 - 2014年到2016 - 2017年，黑人的这种差异有所改善（比值比 = 1.08，95%置信区间 = 1.04 - 1.11），但在2016 - 2017年仍然存在（比值比 = 0.84，95%置信区间 = 0.81 - 0.87）。2013 - 2014年，患有高血压的黑人和白人之间存在差异（比值比 = 0.92，95%置信区间 = 0.89 - 0.95），但在2016 - 2017年不存在。然而，所有组的参保率在不同时期均有所下降。例如，在总样本中，参保几率从2013 - 2014年到2016 - 2017年下降了22%（比值比 = 0.78，95%置信区间 = 0.75 - 0.81）。
在这两个时期，患有糖尿病的医疗保险受益人群中的黑人和白人之间，以及2013 - 2014年患有高血压的人群中，在药物治疗管理参保方面存在种族差异。由于不同时期总体参保率下降，对项目参保情况的担忧仍然存在。
