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General interest items edited by Janice Flahiff

[Repost] Prescription Drug Use Among Medicare Patients Highly Inconsistent

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From the 17 October 2013 Science Daily article

 A new report from the Dartmouth Atlas Project shows that the use of both effective and risky drug therapies by Medicare patients varies widely across U.S. regions, offering further evidence that location is a key determinant in the quality and cost of the medical care that patients receive.

In their first look at prescription drug use, Dartmouth researchers also find that the health status of a region’s Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains differences in the quality and quantity of prescription drug use.

“There is no good reason why heart attack victims living in Ogden, Utah, are twice as likely to receive medicine to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas, but this inconsistency reflects the current practice of medicine in the United States,” said Jeffrey C. Munson, M.D., M.S.C.E., lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice.

“This report demonstrates how far we still have to go as a nation to make sure people get the care they need when they need it,” said Katherine Hempstead, Ph.D., M.A., senior program officer at the Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project. “Instead of varying widely, patterns of care should be nearly uniform across the country for non- controversial drug therapies with a strong evidence for their use.”

The new report offers an in-depth look at how prescription drugs are used by Medicare beneficiaries in the program’s Part D drug benefit, which had 37 million enrollees in 2012. The report separates the country into 306 regional health care markets and examines variations among them in the quantity and quality of prescription drug use, spending, and use of brand name drugs. To examine the quality of care, the report looks at prescription use in three categories:

  •  Drug therapies proven to be effective for patients who have suffered heart attacks, have diabetes, or have broken a bone;
  •  Discretionary medications, which have less clear benefits, but may be effective for some patients who take them; and
  •  Potentially harmful medications, for which risks generally outweigh benefits. 1

Read the entire article here

The full Dartmouth report may be found here

October 18, 2013 Posted by | health care | , , , | Leave a comment

What Does the Dartmouth Atlas Have to Say About the Politics of the ACA?

From the 27 December 2012 article at The Health Care Blog by Anubhav Kaul, MD, Peter Bhandari, and Thom Walsh, PhD

…The Dartmouth Atlas Project is an online database which collects Medicare spending and utilization data from around the country. Information gathered from the database has shown immense variation in the way medical resources are utilized by even similar regions, communities, and health care organization. Evidence has repeatedly shown that, from a population perspective, areas that spend more on medical care do not consistently benefit from increased quality of care or patient wellbeing. Variation in the type of care delivered can be attributed to diverse incidence and prevalence of disease severity or the type of care a well- informed patient chooses. Variation in health care delivery is thus omnipresent and expected, because every patient is unique and medical innovation presents a growing number of care options to choose from….

[The interactive map may be found here]

The top ten Republican states have higher Medicare spending than the top ten Democratic states. The rate of hospitalization and surgical procedures are also higher for Republican states. If we investigate a procedure like percutaneous coronary interventions (PCI), the Republican states are performing more PCI procedures with equal mortality benefit compared to Democratic states. The evidence of variation in cost and utilization is a strong indication of inconsistency and inefficiency in the care delivery process. Are the Republican states providing better care by providing more care? We cannot find evidence of for such an assertion. Nor do we find evidence of harm occurring from a lack of utilization to individuals residing in democratic states. Six of the ten Republican states sued the federal government over the individual mandate and Medicaid expansion earlier this year (Utah, Alabama, Louisiana, Texas, Georgia, and Nebraska), compared to only one democratic majority state (Maine). Yet the Republican states have a higher average of uninsured people, thus inhibiting a greater percentage of their citizens from accessing preventive healthcare….

Read the entire article here

December 28, 2012 Posted by | health care | , , , , | Leave a comment

   

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