Prescription Drug Coverage and Health Outcomes in Elders

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DESCRIPTION (provided by applicant): Dr. Jennifer Tjia, a Geriatrics Fellow at the University of Pennsylvania, is dedicated to a career in Geriatric Health Services Research. Dr. Tjia's goal is to develop a multidisciplinary research program to (1) understand the effect of state & federal prescription drug policies on elder health outcomes and health service use and (2) understand the predictors of medication uptake and adherence among older adults. This Mentored Clinical Scientist Career Development Award will provide the means to take two important steps toward this goal. First, it will allow for additional intensive mentored education and training in public policy research, health economics, and advanced statistics that will augment previous rigorous training in epidemiology, biostatistics, and clinical medicine. Second, it will support the development of an original clinical research program using rigorous epidemiologic and econometric methods to examine the impact of prescription drug coverage on health outcomes. As new prescription drugs contribute to rising health care costs and the promise of improved health, it is important to understand how prescription drug insurance affects the health and medical service utilization of older adults. Although some policymakers argue that the provision of a pharmacy benefit may reduce costs through reduced health service utilization and improved health, evidence to support this assertion is lacking. The candidate proposes two complementary studies at both the national and state levels to address the important, unanswered questions about medication access by older adults. Study One is a national-level observational cohort study using data from the Medicare Current Beneficiary Survey (MCBS) to examine the effect of drug coverage on the incidence of adverse events and medication persistence. Study Two is a health policy natural experiment using North Carolina Medicaid claims to measure the effect of a new drug benefit program on adverse events and state health care expenditures. This two-part research program will triangulate on the nexus of issues central to understanding the effect of prescription drug policy on elder health outcomes and form the foundation for the candidate's transition to an independent investigator in Geriatric Health Services Research.