Health care financing transitions non adherence to medication among va patients with hypertension
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Health Care Financing Transitions & Non-Adherence to Medication Among VA Patients with Hypertension. Julia Prentice* Health Care Financing and Economics, VA Boston Healthcare System Steve Pizer Health Care Financing and Economics, VA Boston Healthcare System and

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Julia Prentice* Health Care Financing and Economics, VA Boston Healthcare System Steve Pizer

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Health care financing transitions non adherence to medication among va patients with hypertension

Health Care Financing Transitions & Non-Adherence to Medication Among VA Patients with Hypertension

Julia Prentice*

Health Care Financing and Economics,

VA Boston Healthcare System

Steve Pizer

Health Care Financing and Economics,

VA Boston Healthcare System

and

Boston University School of Public Health

Antoun Houranieh

Pharmaceutical Services

VA Boston Healthcare System

*This study was funded by the Department of Veterans Affairs Health Services Research and Development Service (ECI 03-199-2).


Hypertension is not well controlled

Hypertension is not Well Controlled

  • Adherence to medication

    - Asymptomatic nature of hypertension

    - Therapy regime

    - Out of pocket costs

  • Gaps or changes in drug coverage

    - One-quarter to one-third of MCBS beneficiaries have

    changes in drug coverage

  • Transition may cause non-adherence (e.g. gaps)

    - Enrollment delays

    - Different formularies, cost-sharing policies (e.g. copays)


Research objective

Research Objective

• Examine the association between changes in drug coverage and gaps in hypertension medication among veterans

- Switch between VA and Medicaid

• Hypothesis: Veterans who switch have a higher risk of experiencing gaps in medication


Veterans may choose va or medicaid

Veterans May Choose VA or Medicaid

• VA

- Low out-of-pocket costs

- Closed network; distance

- Long waits

• Medicaid

- Local provider

- Eligibility requirements/benefits vary

• Changes in health may influence program choice


Study population

Study Population

  • VA and Medicaid dual enrollees

    -Hypertension diagnosis

    -Prescription claims for hypertension drugs

    - Alpha-blockers

    - Beta-blockers

    - Calcium-channel blockers

    - Diuretics

    - Angiotensin converting enzyme (ACE) inhibitors

    • Minimized likelihood of drug coverage from other sources


Medication gap definition

Medication Gap Definition

  • Continuous Multiple-Interval Measure of Medication Gaps (CMG)

    CMG= # of days without drugs

    total number of treatment days

  • Percentage of days without medication

    - 0 to 1

    - 0= individual always has needed medication

    - 1= individual never has needed medication


Financing transition definition

Financing Transition Definition

X=VA prescriptionO=Medicaid prescription


Switching once has higher non adherence

Switching Once Has Higher Non-Adherence


Analyses

Analyses

  • Switching predicting medication gaps

    - Switched once versus using one program or

    both programs

  • Risk adjusted models

    • Demographics (e.g. age, gender)

      - 28 health conditions (e.g. alcohol abuse, diabetes)


Ols results

OLS Results


Julia prentice health care financing and economics va boston healthcare system steve pizer

Switching Significantly Predicts Gaps

p<0.05

p<0.05


Instrumental variables regression

Instrumental Variables Regression

  • Joint determination of switching and medication gaps

    - Health shock could cause both simultaneously

    • Two-stage Instrumental Variables Regression

    - First stage predicts switching

    - Uses accessibility (e.g. VA distance) and eligibility

    factors (e.g. Medicaid restrictiveness)

    - Second stage includes the predicted probability of

    switching


Iv model

IV Model


Julia prentice health care financing and economics va boston healthcare system steve pizer

IV Results

p<0.05

OLS Results

p<0.05

p<0.05


Conclusions and implications

Conclusions and Implications

  • IV required to control for joint determination

  • Switching drug coverage increases risk of medication gaps for some drug classes

    - Beta-blockers, Calcium channel blockers, ACE inhibitors

    - Switching does not influence alpha-blockers or diuretics

  • Veterans entering or exiting VA system at higher risk for non-adherence

    - Medicare Part D

    - Department of Defense


Conclusions and implications1

Conclusions and Implications

  • Confirm importance of drug cost control policies

    - Transition problematic due to enrollment delays or

    drug cost control policies

    - Same relationship for all classes expected if enrollment

    delays

    - No relationship seen for cheap (diuretics) or rarely

    used (alpha-blockers) drugs

    - Different drug cost control policies (e.g. formulary

    restrictions, copays) may lead to gaps in other classes


Contact information

Contact Information

  • Julia Prentice

    [email protected]

  • Steve Pizer

    [email protected]

  • Antoun Houranieh

    [email protected]


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