Sedative Hypnotic Use by the Mentally Ill: A Medicaid Prescription Policy Study

描述(申请人提供)：失眠是精神病患者的常见症状，包括抑郁、焦虑症、注意力缺陷多动障碍和精神分裂症；失眠同时影响功能和精神健康治疗结果1-4失眠的有效治疗已被证明对治疗结果、健康和生活质量产生积极影响2，4-7州医疗补助主任将失眠药物的使用列为需要评估的关键问题，因为在实施针对镇静催眠的获取政策后，出于对支出和替代低剂量非典型抗精神病药物的担忧。8我们将开发一个汇集的多状态医疗补助数据集，以研究与精神药物处方获取政策实施相关的医疗服务利用(包括精神药物使用)的变化。我们将首先使用这个数据库来研究MI患者服用镇静催眠处方药的个人的处方和非处方药使用情况。我们将对科罗拉多州、俄勒冈州和堪萨斯州合作州的使用趋势进行实施前/实施后的政策分析，比较三种镇静催眠药准入限制政策(首选药物清单、事先授权和费用分担)的影响。每个州的分析队列都是有心肌梗死诊断的人。子分析的诊断特定子组包括抑郁症、焦虑症、多动症和精神分裂症患者。我们将量化政策实施对总队列和特定诊断亚组中的药物和服务利用、替代和支出的影响。具体目标1：在患有精神疾病的医疗补助受益人中，比较2002-2007年间三个州医疗补助计划中新的镇静催眠药单独和与其他精神药物联合使用的趋势。具体目标2：审查处方获取政策对新的镇静催眠药的使用的影响，每个州在政策实施前后的情况，以及替代其他精神药物的可能性，如小剂量非典型抗精神病药物。具体目标3：比较实施处方药准入限制政策对医疗补助受益人的处方药总支出和服务利用支出的影响，以及政策实施前后的心理健康诊断。 公共卫生相关性：我们将开发一个汇集的多州医疗补助数据集，以研究与科罗拉多州、堪萨斯州和俄勒冈州的精神药物获取政策设计、实施和使用相关的医疗利用变化。我们将首先使用这个数据库来研究服用镇静催眠处方药的精神疾病患者的处方药和服务利用情况。研究处方药获取限制对处方药和非处方药服务的利用以及总体医疗支出的影响，将使医疗补助计划能够改进处方药福利设计，并实施精神药物处方药获取政策，以优化健康状况并最大限度地提高每一笔医疗保健美元的收益。

DESCRIPTION (provided by applicant): Insomnia is a common symptom in individuals with mental illness (MI), including depression, anxiety disorders, attention deficit hyperactivity disorder (ADHD) and schizophrenia; insomnia affects both functioning and mental health treatment outcomes.1-4 Effective treatment of insomnia has been shown to positively impact treatment outcomes, health and quality of life in this population.2, 4-7 State Medicaid Directors identify the utilization of insomnia drugs as a critical issue needing evaluation because of concerns about expenditures and substitution to low-dose atypical antipsychotics after they implement access policies directed at sedative hypnotics.8 We will develop a pooled multi-state Medicaid dataset to study changes in health service utilization (including psychotropic medication utilization) associated with psychotropic prescription access policy implementation. We will initially use this database to study prescription and non-prescription utilization by individuals with MI prescribed sedative hypnotic prescription drugs. We will conduct a pre/post-implementation policy analyses of utilization trends within the collaborating states of Colorado, Oregon and Kansas, comparing the impact of three sedative hypnotic access restriction policies (preferred drug lists, prior authorization and cost sharing). Each state's analysis cohort is all people with an MI diagnosis. Diagnosis-specific subgroups for sub-analyses are people with depression, anxiety disorders, ADHD and schizophrenia. We will quantify the effect of policy implementation on medication and service utilization, substitution and expenditures in the total cohort and the diagnosis-specific subgroups. Specific Aim 1: Among Medicaid beneficiaries with a mental illness, compare utilization trends of newer sedative hypnotics, alone and in combination with other psychotropics, across three state Medicaid programs from 2002-2007. Specific Aim 2: Examine the effects of prescription access policies on the utilization of newer sedative hypnotics, pre-to-post policy implementation in each state, and potential substitutions to other psychotropic drugs such as low dose atypical antipsychotics. Specific Aim 3: Compare the impact of implementing prescription access restriction policies on overall prescription drug expenditures and service utilization expenditures among Medicaid beneficiaries with a mental health diagnosis, pre- and post-policy implementation. PUBLIC HEALTH RELEVANCE: We will develop a pooled multistate Medicaid dataset in order to study health care utilization changes associated with psychotropic drug access policy design, implementation and utilization in Colorado, Kansas and Oregon. We will initially use this database to study prescription drug and service utilization of individuals with mental illness that take sedative hypnotic prescription drugs. Research on the impact of prescription access restrictions on the utilization of prescription and non-prescription services, and overall healthcare expenditures, will permit Medicaid programs to refine prescription benefit design, as well as implement psychotropic prescription access policies that optimize health status and maximize the yield of each health care dollar.