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Association of potentially inappropriate medication use with patient and prescriber characteristics in Medicare Part D

Authors

  • Holly M. Holmes,

    Corresponding author
    • Department of General Internal Medicine, UT MD Anderson Cancer Center, Houston, TX, USA
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  • Ruili Luo,

    1. Department of General Internal Medicine, UT MD Anderson Cancer Center, Houston, TX, USA
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  • Yong-Fang Kuo,

    1. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
    2. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
    3. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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  • Jacques Baillargeon,

    1. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
    2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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  • James S. Goodwin

    1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
    2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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  • The research in this manuscript was presented in part at the CMS Symposium in Hunt Valley Maryland in March 2012.

Correspondence to: H. M. Holmes, UT MD Anderson Cancer Center, 1400 Pressler, Unit 1465, Houston, TX, 77030, USA. E-mail: hholmes@mdanderson.org

ABSTRACT

Purpose

The use of potentially inappropriate medications (PIMs) in older people is associated with increased risk of adverse drug events and hospitalization. This study aimed to determine the contribution of primary prescribers to variation in PIM use.

Methods

This was a retrospective cohort study using 2008 Medicare Part D event files and claims data for a 100% sample of Texas beneficiaries. PIM use was defined as receiving any of 48 medications on the Beers 2003 list of PIMs. Patient characteristics associated with PIM use were determined using a multivariable model. A multilevel model for the odds of PIM use was constructed to evaluate the amount of variation in PIM use at the level of primary care prescriber, controlling for patient characteristics.

Results

Of 677 580 patients receiving prescriptions through Part D in 2008, 31.9% received a PIM. Sex, ethnicity, low-income subsidy eligibility, and hospitalization in 2007 were associated with PIM use. The strongest associations with higher PIM use were increasing number of prescribers and increasing number of medications. The odds ratio for PIM use was 1.50 (95%CI 1.47–1.53) for ≥4 prescribers versus only 1 prescriber. In the multilevel model, the adjusted average percent of patients prescribed a PIM ranged from 17.5% for the lowest decile to 28.9% for the highest decile of prescribers.

Conclusions

PIM use was prevalent in Part D beneficiaries and varied among individual primary care prescribers. The association of PIM use with increasing numbers of prescribers suggests the need to reduce fragmentation of care to reduce inappropriate prescribing. Copyright © 2013 John Wiley & Sons, Ltd.

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