Health care financing transitions non adherence to medication among va patients with hypertension
Download
1 / 17

Julia Prentice* Health Care Financing and Economics, VA Boston Healthcare System Steve Pizer - PowerPoint PPT Presentation


  • 98 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Julia Prentice* Health Care Financing and Economics, VA Boston Healthcare System Steve Pizer' - rashad-fischer


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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 Medication Among

  • 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 Medication Among

• 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 Medication Among

• 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 Medication Among

  • 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 Medication Among

  • 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 Medication Among

X=VA prescription O=Medicaid prescription



Analyses
Analyses Medication Among

  • 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 Medication Among


Switching Significantly Predicts Gaps Medication Among

p<0.05

p<0.05


Instrumental variables regression
Instrumental Variables Regression Medication Among

  • 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 Medication Among


IV Results Medication Among

p<0.05

OLS Results

p<0.05

p<0.05


Conclusions and implications
Conclusions and Implications Medication Among

  • 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 Medication Among

  • 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 Medication Among

  • Julia Prentice

    [email protected]

  • Steve Pizer

    [email protected]

  • Antoun Houranieh

    [email protected]


ad