Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries
Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries
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DOI：
10.1007/s11606-017-4167-y
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发表时间：
2018-01-01
影响因子：
5.7
通讯作者：
Kerr, Eve A.
中科院分区：
文献类型：
--
作者：
Maciejewski, Matthew L.;Mi, Xiaojuan;Kerr, Eve A.
在临床上，糖尿病治疗的去强化通常适用于老年人，因为积极的糖尿病治疗的益处随着年龄的增长而下降，而风险则增加。我们检查了老年糖尿病患者过度治疗和去强化治疗的比率，以及这些比率是否因医疗、人口统计学和社会经济特征而不同。我们分析了来自10个州的医疗保险索赔数据，与门诊实验室检查值相关联，以识别可能过度治疗糖尿病的患者（HbA 1c < 6.5%，使用二甲双胍以外的任何糖尿病药物，2011年1月1日至2011年6月30日）。我们研究了可能过度治疗的糖尿病患者与去强化相关的特征。我们使用多项逻辑回归来检查与糖尿病过度治疗相关的患者特征是否与治疗不足相关的患者特征不同（即HbA 1c> 9.0%）。在78，792名患有糖尿病的医疗保险接受者中，8560人（10.9%）可能过度治疗。糖尿病过度治疗在75岁以上的老年人和参加医疗补助的人中更常见（p < 0.001），在西班牙裔人中不太常见（p = 0.009）。14%的过度治疗糖尿病患者的治疗强度降低。糖尿病治疗适当的去强化治疗在患有六种或六种以上慢性疾病、门诊就诊较多或居住在城市地区的患者中更为常见;去强化治疗在75岁以上的患者中不太常见。只有6.9%的糖尿病医疗保险接受者可能治疗不足。与糖尿病过度治疗相关的变量不同于与治疗不足相关的变量。医疗保险接受者更经常地过度治疗而不是治疗不足。过度治疗糖尿病的医疗保险接受者很少有他们的方案减弱。
Deintensification of diabetic therapy is often clinically appropriate for older adults, because the benefit of aggressive diabetes treatment declines with age, while the risks increase.We examined rates of overtreatment and deintensification of therapy for older adults with diabetes, and whether these rates differed by medical, demographic, and socioeconomic characteristics.We analyzed Medicare claims data from 10 states, linked to outpatient laboratory values to identify patients potentially overtreated for diabetes (HbA1c < 6.5% with fills for any diabetes medications beyond metformin, 1/1/2011-6/30/2011). We examined characteristics associated with deintensification for potentially overtreated diabetic patients. We used multinomial logistic regression to examine whether patient characteristics associated with overtreatment of diabetes differed from those associated with undertreatment (i.e. HbA1c > 9.0%).Of 78,792 Medicare recipients with diabetes, 8560 (10.9%) were potentially overtreated. Overtreatment of diabetes was more common among those who were over 75 years of age and enrolled in Medicaid (p < 0.001), and was less common among Hispanics (p = 0.009). Therapy was deintensified for 14% of overtreated diabetics. Appropriate deintensification of diabetic therapy was more common for patients with six or more chronic conditions, more outpatient visits, or living in urban areas; deintensification was less common for those over age 75. Only 6.9% of Medicare recipients with diabetes were potentially undertreated. Variables associated with overtreatment of diabetes differed from those associated with undertreatment.Medicare recipients are more frequently overtreated than undertreated for diabetes. Medicare recipients who are overtreated for diabetes rarely have their regimens deintensified.