Racial and ethnic disparities in Medicare Part D medication therapy management services utilization

被引:4
|
作者
Dong, Xiaobei [1 ]
Tsang, Chi Chun Steve [2 ]
Browning, Jamie A. [3 ]
Garuccio, Joseph [3 ]
Wan, Jim Y. [4 ]
Shih, Ya Chen Tina [5 ]
Chisholm-Burns, Marie A. [6 ]
Dagogo-Jack, Samuel [7 ]
Cushman, William C. [8 ]
Wang, Junling [9 ]
Wang, Junling [9 ]
机构
[1] Univ Wisconsin Milwaukee, Joseph J Zilber Sch Publ Hlth, 1240 N 10th St, Milwaukee, WI 53205 USA
[2] Univ Tennessee, Dept Clin Pharm & Translat Sci, Hlth Outcomes & Policy Res, Hlth Sci Ctr,Coll Pharm, 881 Madison Ave,Room 212, Memphis, TN 38163 USA
[3] Univ Tennessee, Dept Clin Pharm & Translat Sci, Hlth Outcomes & Policy Res, Hlth Sci Ctr,Coll Pharm, 881 Madison Ave, Memphis, TN 38163 USA
[4] Univ Tennessee, Dept Prevent Med, Hlth Sci Ctr, Coll Pharm, 66 N Pauline,Suite 633, Memphis, TN 38163 USA
[5] Univ Texas MD Anderson Canc Ctr, Sect Canc Econ & Policy, Dept Hlth Serv Res, 1515 Holcombe Blvd,Unit 1444, Houston, TX 77030 USA
[6] Oregon Hlth & Sci Univ, Sch Med, 3181 Sam Jackson Pk Rd, Portland, OR 97236 USA
[7] Univ Tennessee, Div Endocrinol Diabet & Metab, Clin Res Ctr, Hlth Sci Ctr, Memphis, TN 38163 USA
[8] Univ Tennessee, Dept Prevent Med, Hlth Sci Ctr, Coll Med, 66 North Pauline St,Suite 651, Memphis, TN 38163 USA
[9] Univ Tennessee, Dept Clin Pharm & Translat Sci, Hlth Sci Ctr, Coll Med, 881 Madison Ave,Room 221, Memphis, TN 38163 USA
来源
EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY | 2023年 / 9卷
基金
美国国家卫生研究院;
关键词
America; Medicare Part D Medication Therapy; Management; Racial and ethnic disparities; Service utilization; Pharmacist; Comprehensive medication review; Targeted medication review; CARE; PHARMACISTS; HEALTH; LANGUAGE; OUTCOMES;
D O I
10.1016/j.rcsop.2023.100222
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Background: 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. Objective: To examine MTM service utilization among older Medicare beneficiaries and to identify any racial and ethnic disparity patterns. Methods: 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. Results: 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. Conclusions: 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.
引用
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页数:9
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