收到老年痴呆患者的医疗保险D部分综合药物审查。

IF 2.9 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of managed care & specialty pharmacy Pub Date : 2025-03-01 DOI:10.18553/jmcp.2025.31.3.296

Antoinette B Coe, Jonathan Martindale, Julie P W Bynum

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引用次数: 0

摘要

背景：老年阿尔茨海默病及相关痴呆（ADRDs）患者发生药物相关问题的风险较高。医疗保险D部分药物治疗管理（MTM）项目要求进行全面的药物审查（CMRs），旨在优化药物使用并减少不良事件。在患有ADRD的受益人中，与MTM资格和CMR收据相关的个体因素尚不清楚。目的：比较老年ADRD患者与非ADRD患者的MTM适格性和CMR接收情况。方法：这项回顾性、横断面研究纳入了2014年健康与退休研究的参与者，年龄至少65岁，持续享受医疗保险按服务收费和D部分保险。结果是2014年或2015年MTM资格和CMR接收。我们的主要自变量是诊断为ADRD的存在。协变量包括社会人口学特征、健康状况和功能限制。采用加权描述性统计、双变量统计和多变量逻辑回归。结果：我们纳入14778,506名老年人，其中10.1%患有ADRD。ADRD患者年龄较大(平均年龄[SE] = 83 [0.6] vs 75[0.2]岁；P = 0.008)，且MTM适格性较高(25.3% vs 14.8%；p = 0.12)。ADRD状态与CMR接收无关（OR = 0.52, 95% CI = 0.23-1.21，调整后OR = 0.75, 95% CI = 0.25-2.29）。结论：与没有ADRD的老年人相比，患有ADRD的老年人不太可能符合MTM条件或接受CMR。需要改进MTM程序设计的策略来增加老年ADRD患者的CMR接收。

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Receipt of Medicare Part D comprehensive medication reviews in older adults with dementia.

Background: Older adults with Alzheimer disease and related dementias (ADRDs) are at high risk for medication-related problems. Comprehensive medication reviews (CMRs), required in Medicare Part D medication therapy management (MTM) programs, aim to optimize medication use and reduce adverse events. Individual factors related to MTM eligibility and CMR receipt among beneficiaries with ADRD are unknown.

Objective: To examine MTM eligibility and CMR receipt among older adults with ADRD compared with those without.

Methods: This retrospective, cross-sectional study included 2014 Health and Retirement Study participants aged at least 65 years, with continuous Medicare fee-for-service and Part D coverage. Outcomes were MTM eligibility and CMR receipt in 2014 or 2015. Our primary independent variable was presence of diagnosed ADRD. Covariates included sociodemographic characteristics, health conditions, and functional limitations. Weighted descriptive and bivariate statistics and multivariable logistic regression were used.

Results: We included 14,778,506 older adults and 10.1% had ADRD. Those with ADRD were older (mean age [SE] = 83 [0.6] vs 75 [0.2] years; P < 0.001), had a higher proportion of Black (11.6% vs 6.3%) and Hispanic (5.7% vs 4.7%) race and ethnicity (P = 0.008), and had higher MTM eligibility (25.3% vs 14.8%; P < 0.001) compared with those without ADRD. Older adults with ADRD were more likely to be eligible for MTM (odds ratio [OR] = 1.95, 95% CI = 1.41-2.70) but not after adjusting for covariates (adjusted OR = 1.41, 95% CI = 0.88-2.27). Overall, 16.9% received a CMR. CMR receipt was lower in those with ADRD compared with those without (10.4% vs 18.2%), but not significantly different (P = 0.12). ADRD status was not associated with CMR receipt (OR = 0.52, 95% CI = 0.23-1.21, adjusted OR = 0.75, 95% CI = 0.25-2.29).

Conclusions: Older adults with ADRD were not more likely to be MTM eligible or receive a CMR compared with those without ADRD. Strategies to improve MTM program design are needed to increase CMR receipt among older adults with ADRD.

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来源期刊

Journal of managed care & specialty pharmacy Health Professions-Pharmacy

CiteScore

3.50

自引率

4.80%

发文量

131

期刊介绍： JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.