Comparative Effectiveness of Medication Therapy Management Eligibility Criteria Across Racial/Ethnic Groups

被引：6

作者：

Spivey, Christina A. ^{[1
]}

Qiao, Yanru ^{[2
]}

Wang, Junling ^{[2
]}

Shih, Ya-Chen Tina ^{[3
]}

Wan, Jim Y. ^{[4
]}

Dagogo-Jack, Samuel ^{[5
,6
]}

Cushman, William C. ^{[7
]}

Hines, Lisa E. ^{[8
]}

Chisholm-Burns, Marie A. ^{[9
,10
,11
]}

机构：

[1] Univ Tennessee, Coll Pharm, Dept Clin Pharm & Translat Sci, Memphis, TN USA

[2] Univ Tennessee, Coll Pharm, Dept Clin Pharm & Translat Sci, Hlth Outcomes & Policy Res, 881 Madison Ave,Room 221, Memphis, TN 38163 USA

[3] Univ Texas MD Anderson Canc, Sect Canc Econ & Policy, Dept Hlth Serv Res & Chief, Houston, TX USA

[4] Univ Tennessee, Coll Med, Dept Prevent Med, Memphis, TN USA

[5] Univ Tennessee, Coll Med, Div Endocrinol Diabet & Metab, Memphis, TN USA

[6] Univ Tennessee, Coll Med, Clin Res Ctr, Memphis, TN USA

[7] Univ Tennessee, Dept Prevent Med & Med, Coll Med & Chief, Prevent Med Sect,Vet Affairs Med Ctr, Memphis, TN USA

[8] Pharm Qual Alliance, Measure Operat & Analyt, Alexandria, VA USA

[9] Univ Tennessee, Coll Pharm, Memphis, TN USA

[10] Univ Tennessee, Coll Pharm, Knoxville, TN USA

[11] Univ Tennessee, Coll Pharm, Nashville, TN USA

来源：

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY | 2019年 / 67卷 / 03期

基金：

美国国家卫生研究院;

关键词：

medication therapy management; Medicare Modernization Act; Affordable Care Act; ETHNIC DISPARITIES; RACIAL DISPARITIES; OLDER-ADULTS; MINORITIES; HEALTH;

D O I：

10.1111/jgs.15754

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

BACKGROUND/OBJECTIVESPrevious research indicates that eligibility criteria for medication therapy management (MTM) services in Medicare prescription drug (Part D) plans, defined under the Medicare Modernization Act (MMA), are associated with racial/ethnic disparities and ineffective in identifying individuals with medication utilization issues. Our study's objective was to determine the comparative effectiveness of MTM eligibility criteria under MMA and in the Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial/ethnic groups. DESIGNACA and MMA MTM eligibility criteria were compared on proportions of eligible individuals among patients with medication utilization issues. Multinomial logistic regression was conducted to control for patient/community characteristics. Need-based and demand-based analyses were used to determine disparities due to need and demand for healthcare. Main/sensitivity analyses were conducted for the range of eligibility thresholds. SETTINGMedicare data (2012-2013) linked to Area Health Resources Files. PARTICIPANTSA total of 964 610 patients 65 years or older. MEASUREMENTSMedication safety/adherence measures, developed primarily by the Pharmacy Quality Alliance, were used to determine medication utilization issues. RESULTSHigher proportions of patients were eligible based on ACA than MMA MTM eligibility criteria. For example, in 2013, proportions based on ACA and MMA MTM eligibility criteria would be 99.7% and 26.2%, respectively, in the main analysis (p < .001); in the demand-based main analysis, ACA criteria were associated with 13.6% and 9.8%, respectively, higher effectiveness than MMA criteria among non-Hispanic blacks and Hispanics than non-Hispanic whites. CONCLUSIONACA MTM eligibility criteria are more effective than MMA criteria in identifying older patients needing MTM, particularly among minorities. J Am Geriatr Soc 67:581-587, 2019.

引用

页码：581 / 587

页数：7

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