Open AccessImplementation of M edicare P art D and statin use among the elderly population with diabetes
Author(s) -
Vaidya Varun,
Blazejewski Lucas,
Pinto Sharrel
Publication year - 2012
Publication title -
journal of pharmaceutical health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.244
H-Index - 15
eISSN - 1759-8893
pISSN - 1759-8885
DOI - 10.1111/j.1759-8893.2012.00098.x
Subject(s) - medicine , statin , medicare part d , diabetes mellitus , logistic regression , guideline , medical prescription , medical expenditure panel survey , confidence interval , prescription drug , population , gerontology , physical therapy , environmental health , health care , health insurance , pathology , economic growth , economics , pharmacology , endocrinology
Objective The A merican D iabetes A ssociation treatment guidelines recommend that patients with diabetes over 40 years of age with one or more risk factors for cardiovascular disease be prescribed statin medication. Despite the guideline, use of statins among elderly patients with diabetes is low. M edicare P art D was implemented in 2006 to increase affordability and access to prescription medications for M edicare enrollees. The main objective of this study was to analyse trend in statin users with diabetes before and after implementation of P art D . Methods Data were obtained from the M edical E xpenditure P anel S urvey for 2004–2008. Patients who were diabetic ( ICD ‐9 code 250) and either elderly (≥65 years) or near elderly (57–64 years) were included in the analysis. C hi‐square analysis was used to compare statin users before and after P art D for both the elderly and near‐elderly populations. For elderly patients, trends in statin users were analysed for subpopulations based on gender, race/ethnicity, income, education level and perceived health status. A logistic regression analysis was conducted to identify factors that predicted use of statin. Key findings Between 2004 and 2008 patients who reported using statins increased from 55.05 to 61.25% for the elderly and from 54.99 to 55.89% for the near elderly. The elderly population had a significant increase in the percentage of patients reporting use of statins after the implementation of P art D ( P = 0.002). Logistic regression identified post‐ P art D period (0.75, 95% confidence interval ( CI ) 0.60–0.94; P = 0.013), female gender (1.28, 95% CI 1.05–1.57; P = 0.013) and A frican‐ A merican race/ethnicity (1.53, 95% CI 1.19–1.96; P < 0.00) as significant predictors of reporting statin use among study population. Conclusion The study results imply that P art D may have influenced an increase in prescriptions of statins to elderly patients with diabetes. Logistic regression and trend analysis indicate that P art D was unable to reduce disparities in prescriptions for racial and gender subgroups.