A new study looks at geographic disparities in the appropriate prescribing of high-risk drugs, and finds that more spending doesn't always lead to better care.
A new report published in the New England Journal of Medicine reveals significant geographic variations in terms of medication errors and appropriate drug prescribing, particularly for elderly patients.
Even after adjusting for variation in demographic characteristics, individual health status, and insurance coverage, lead author Yuting Zhang, PhD, of the University of Pittsburgh, and colleagues found that Medicare spending on pharmaceuticals differs substantially among US localities and hospital-referral regions.
In their assessment of geographic variation in the management of medication in the elderly, Zhang and colleagues used two quality measures from the Healthcare Effectiveness Data and Information Set (HEDIS) to assess whether Medicare beneficiaries:
The investigators used pharmacy and medical claims data from a random sample of 5% of Medicare beneficiaries who were enrolled in stand-alone Medicare Part D plans in 2007. Each person in the resulting sample of 533,170 beneficiaries was assigned to one of the 306 Dartmouth hospital-referral regions on the basis of the ZIP Code of residence.
To determine the amount of variation in the use of high-risk medications, Zhang and colleagues calculated the proportion of beneficiaries in each hospital-referral region who had received at least one high-risk drug in 2007. They assessed the potentially harmful drug-disease interactions for each of the three conditions separately and used a combination measure indicating the proportion of patients with at least one of the three conditions who were taking any potentially harmful drug. They then calculated the proportion of beneficiaries with dementia in each hospital-referral region who had received a potentially harmful drug in 2007.
The three key messages from the analysis, they wrote, are as follows:
In conclusion, according to HEDIS measures of potentially dangerous prescribing patterns, the quality of prescribing for the elderly varies substantially among local markets—substantially more, in fact, than does spending on drugs overall. These results do not support the theory that high-spending areas simply use more of everything, including inappropriate drugs, since the association between overall drug spending and inappropriate prescribing is weak. In addition, because spending on nondrug medical care is positively associated with a greater use of potentially harmful drugs, these findings also do not suggest that more medical spending is associated with better health care overall. These results are consistent, however, with an association between lower-quality prescription patterns and more adverse drug events that may require additional expense to treat.
To access the report, click here.
Are you surprised that the study found that higher medical spending does not necessarily lead result in better care overall? What implications do these findings have in terms of health care reform?