Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar I disorder among dual beneficiaries.
Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar I disorder among dual beneficiaries.
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DOI：
10.1176/appi.ps.201300123
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发表时间：
2014-03-01
期刊：
影响因子：
--
通讯作者：
Huskamp HA
中科院分区：
文献类型：
--
作者：
Burns ME;Busch AB;Madden JM;Le Cates RF;Zhang F;Adams AS;Ross-Degnan D;Soumerai SB;Huskamp HA
2006年1月，药物保险覆盖范围从医疗补助计划转移到医疗保险D部分私人药物计划，涵盖600万参加这两个计划的个人。受益人面临新的处方和使用管理政策。与医疗补助相比，不确定D部分是否放松或收紧了精神病药物管理，这可能会影响接受推荐的药物治疗，以及与治疗中断相关的急诊室使用。本研究探讨了从医疗补助到D部分的过渡对双相I型障碍的指南一致性药物治疗和急诊室使用的影响。使用2004-2007年的中断时间序列和医疗补助和医疗保险管理数据，作者分析了覆盖范围转换对接受指南一致的抗躁狂药物治疗，指南不一致的抗抑郁药单药治疗和急诊科就诊的影响，该研究针对一个全国代表性的连续队列，其中包括1，431名诊断为双相I型障碍的成年人。在过渡期后16个月，使用任何推荐的抗躁狂药物的人群比例估计比控制基线趋势的预期高出3.1个百分点。每月接受抗抑郁药单药治疗7天以上的受益人比例比预期低2.1个百分点。每月急诊就诊人数在过渡后立即增加了19%。双相I型障碍指南一致性药物治疗的增加可能反映了D部分抗躁狂药物的限制性管理相对较少。由于效应量较小，这些变化的临床意义尚不清楚。然而，增加急诊室访问值得关注的医疗补助受益人谁继续过渡到D部分。
In January 2006 drug insurance coverage shifted from Medicaid to Medicare Part D private drug plans for the 6 million individuals enrolled in both programs. Beneficiaries faced new formularies and utilization management policies. It is uncertain if Part D, when compared to Medicaid, relaxed or tightened psychiatric medication management, which could affect receipt of recommended pharmacotherapy, and emergency department use related to treatment discontinuities. This study examined the impact of the transition from Medicaid to Part D on guideline-concordant pharmacotherapy for bipolar I disorder and emergency department use. Using interrupted time series and Medicaid and Medicare administrative data from 2004–2007, the authors analyzed the effect of the coverage transition on receipt of guideline-concordant anti-manic medication, guideline-discordant antidepressant monotherapy, and emergency department visits for a nationally-representative continuous cohort of 1,431 adults diagnosed with bipolar I disorder. Sixteen months after the transition, the proportion of the population with any recommended anti-manic use was an estimated 3.1 percentage points higher than expected controlling for baseline trends. The monthly proportion of beneficiaries with 7+ days of antidepressant monotherapy was 2.1 percentage points lower than expected. The number of emergency department visits per month increased by 19% immediately post-transition. Increased receipt of guideline-concordant pharmacotherapy for bipolar I disorder may reflect relatively less restrictive management of anti-manic medications under Part D. The clinical significance of these changes is unclear given the small effect sizes. However, increased emergency department visits merit attention for the Medicaid beneficiaries who continue to transition to Part D.
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影响因子：
6.6
作者：
Li, JM;McCombs, JS;Stimmel, GL
通讯作者：
Stimmel, GL
影响因子：
9.7
作者：
Polinski, Jennifer M.;Wang, Philip S.;Fischer, Michael A.
通讯作者：
Fischer, Michael A.
影响因子：
3
作者：
Busch, Alisa B.;Huskamp, Haiden A.;McGuire, Thomas G.
通讯作者：
McGuire, Thomas G.
影响因子：
120.7
作者：
Soumeral, SB;McLaughlin, TJ;Goldman, L
通讯作者：
Goldman, L
D 部分和双重资格的精神疾病患者：药物获取问题和强化服务的使用。
DOI：
10.1176/ps.2009.60.9.1169
发表时间：
2009-09
期刊：
Psychiatric services (Washington, D.C.)
影响因子：
--
作者：
Huskamp HA;West JC;Rae DS;Rubio-Stipec M;Regier DA;Frank RG
通讯作者：
Frank RG