Part D and dually eligible patients with mental illness: medication access problems and use of intensive services.
Part D and dually eligible patients with mental illness: medication access problems and use of intensive services.
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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
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发表时间：
2009-09
期刊：
影响因子：
--
通讯作者：
Frank RG
中科院分区：
文献类型：
--
作者：
Huskamp HA;West JC;Rae DS;Rubio-Stipec M;Regier DA;Frank RG
本研究调查了双重资格者从医疗补助药物覆盖过渡到D部分后，药物获取问题的发生和密集精神卫生服务的使用。从美国医学协会医师档案中随机选择的精神科医生报告了2006年前12个月系统选择的双重资格患者（n=908）的经历。倾向评分匹配用于比较精神病急诊室和住院治疗的使用，这些患者在D部分后遇到了获得精神药物的问题，而那些没有。据报道，大约44%的双重资格患者在获得药物方面遇到了问题。与没有出现问题的人相比，出现问题的人去急诊室就诊的可能性明显更高（平均OR=1.75，平均p值=0.003）。在急诊室使用条件和住院使用条件下，急诊室就诊次数没有差异。许多双重资格的患者在D部分实施后难以获得精神药物。遇到困难的患者比没有遇到困难的患者更有可能使用精神科急诊室护理。虽然没有明确的证据表明转向D部分对双重资格的非药物医疗保健福利的成本抵消，但这些发现引起了对潜在抵消和可能对医疗质量产生负面影响的关注。需要进一步的研究来了解D部分对双重资格患者的结局和功能以及治疗费用的全部影响。
This study examined the occurrence of medication access problems and use of intensive mental health services after the transition from Medicaid drug coverage to Part D for dual-eligibles. Psychiatrists randomly selected from American Medical Association’s Physicians Masterfile reported on experiences in the first twelve months of 2006 of one systematically-selected dual-eligible patient (n=908). Propensity score matching was used to compare use of psychiatric emergency room and inpatient care for individuals who experienced a problem accessing a psychiatric medication after Part D and those who did not. Approximately 44% of dual-eligible patients were reported to experience a problem accessing medications. The likelihood of having an emergency room visit was significantly higher for those who experienced a problem compared to those who did not (mean OR=1.75, mean p-value=0.003). There was no difference in number of emergency room visits conditional on emergency room use or in hospitalization use. Many dual-eligible patients experienced difficulty accessing psychiatric medications after Part D’s implementation. Patients who experienced difficulties were significantly more likely to use psychiatric emergency room care than patients who did not experience difficulties. While not definitive evidence of a cost offset onto non-drug health care benefits of the switch to Part D for dual-eligibles, these findings raise concerns about potential offsets and possible negative impacts on quality of care. Additional study is needed to understand the full effects of Part D on outcomes and functioning as well as treatment costs for dual-eligibles.
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影响因子：
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作者：
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