Medication oversupply in patients with diabetes. Res Social Adm Pharm 2015;11(3):382-400
Date
10/08/2014Pubmed ID
25288448Pubmed Central ID
PMC4362914DOI
10.1016/j.sapharm.2014.09.002Scopus ID
2-s2.0-84927961946 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Studies in integrated health systems suggest that patients often accumulate oversupplies of prescribed medications, which is associated with higher costs and hospitalization risk. However, predictors of oversupply are poorly understood, with no studies in Medicare Part D.
OBJECTIVE: The aim of this study was to describe prevalence and predictors of oversupply of antidiabetic, antihypertensive, and antihyperlipidemic medications in adults with diabetes managed by a large, multidisciplinary, academic physician group and enrolled in Medicare Part D or a local private health plan.
METHODS: This was a retrospective cohort study. Electronic health record data were linked to medical and pharmacy claims and enrollment data from Medicare and a local private payer for 2006-2008 to construct a patient-quarter dataset for patients managed by the physician group. Patients' quarterly refill adherence was calculated using ReComp, a continuous, multiple-interval measure of medication acquisition (CMA), and categorized as <0.80 = Undersupply, 0.80-1.20 = Appropriate Supply, >1.20 = Oversupply. We examined associations of baseline and time-varying predisposing, enabling, and medical need factors to quarterly supply using multinomial logistic regression.
RESULTS: The sample included 2519 adults with diabetes. Relative to patients with private insurance, higher odds of oversupply were observed in patients aged <65 in Medicare (OR = 3.36, 95% CI = 1.61-6.99), patients 65+ in Medicare (OR = 2.51, 95% CI = 1.37-4.60), patients <65 in Medicare/Medicaid (OR = 4.55, 95% CI = 2.33-8.92), and patients 65+ in Medicare/Medicaid (OR = 5.73, 95% CI = 2.89-11.33). Other factors associated with higher odds of oversupply included any 90-day refills during the quarter, psychotic disorder diagnosis, and moderate versus tight glycemic control.
CONCLUSIONS: Oversupply was less prevalent than in previous studies of integrated systems, but Medicare Part D enrollees had greater odds of oversupply than privately insured individuals. Future research should examine utilization management practices of Part D versus private health plans that may affect oversupply.
Author List
Thorpe CT, Johnson H, Dopp AL, Thorpe JM, Ronk K, Everett CM, Palta M, Mott DA, Chewning B, Schleiden L, Smith MAAuthor
Christine M. Everett PhD, PAC Chief, Director, Professor in the Health Sciences Education department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Age FactorsAged
Antihypertensive Agents
Cohort Studies
Diabetes Mellitus
Drug Prescriptions
Drug Utilization
Electronic Health Records
Female
Humans
Hypoglycemic Agents
Hypolipidemic Agents
International Classification of Diseases
Male
Medicare Part D
Medication Adherence
Middle Aged
Prescription Drugs
Retrospective Studies
Sex Factors
United States
Wisconsin
