Medicare Part D and Long-Term Care: A Systematic Review of Quantitative and Qualitative Evidence

BACKGROUND: In the largest overhaul to Medicare since its creation in 1965, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established Part D in 2006 to improve access to essential medication among disabled and older Americans. Despite previous evidence of a positive impact on the general Medicare population, Part D\u27s overall effects on long-term care (LTC) are unknown. OBJECTIVE: The purpose of this systematic review was to evaluate the literature regarding Part D\u27s impact on the LTC context, specifically costs to LTC residents, providers and payers; prescription drug coverage and utilization; and clinical and administrative outcomes. DATA SOURCES: Four electronic databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Business Fulltext Elite and Science Citation Index Expanded], selected US government and non-profit websites, and bibliographies were searched for quantitative and qualitative studies characterizing Part D in the LTC context. Searches were limited to studies that may have been published between 1 January 2006 (date of Part D implementation) and 8 January 2013. STUDY SELECTION: Systematic searches identified 1,624 publications for a three-stage (title, abstract and full-text) review. Included publications were in English language; based in the US; assessed Part D-related outcomes; and included or were directly relevant to LTC residents or settings. News articles, reviews, opinion pieces, letters or commentaries; case reports or case series; simulation or modeling studies; and summaries that did not report original data were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS: A standardized form was used to abstract study type, study design, LTC setting, sources of data, method of data collection, time periods assessed, unit of observation, outcomes and results. Methodological quality was assessed using modified criteria specific to quantitative and qualitative studies. RESULTS: Eleven quantitative and eight qualitative studies met inclusion criteria. In the seven years since its implementation, Part D decreased out-of-pocket costs among enrolled nursing home residents and potentially increased costs borne by LTC facilities. Coverage of prescription drugs frequently used by older adults was adequate, except for certain drugs and alternative formulations of importance to LTC residents. The use of medications that raise safety concerns was decreased, but overall drug utilization may have been unaffected. Although there was uncertain impact on clinical outcomes, quantitative studies demonstrated evidence of unintended health consequences. Qualitative studies consistently revealed increased administrative burden among providers. LIMITATIONS: Empirical evidence of Part D\u27s LTC impact was sparse. Due to limitations in available types of data, quantitative studies were generically lacking in methodological rigor. Qualitative studies suffered from lack of clarity of reporting. As future studies use clinical Medicare data, study quality is expected to improve. CONCLUSION: Although LTC-specific policies continue to evolve, it appears that the prescription drug benefit may require further modifications to more effectively provide for LTC residents\u27 unique medication needs and improve their health outcomes. Adjustments may be needed for Part D to be more compatible with LTC prescription drug delivery processes

Systematic review on quality control for drug management programs: Is quality reported in the literature?

<p>Abstract</p> <p>Background</p> <p>Maintaining quality of care while managing limited healthcare resources is an ongoing challenge in healthcare. The objective of this study was to evaluate how the impact of drug management programs is reported in the literature and to identify potentially existing quality standards.</p> <p>Methods</p> <p>This analysis relates to the published research on the impact of drug management on economic, clinical, or humanistic outcomes in managed care, indemnity insurance, VA, or Medicaid in the USA published between 1996 and 2007. Included articles were systematically analyzed for study objective, study endpoints, and drug management type. They were further categorized by drug management tool, primary objective, and study endpoints.</p> <p>Results</p> <p>None of the 76 included publications assessed the overall quality of drug management tools. The impact of 9 different drug management tools used alone or in combination was studied in pharmacy claims, medical claims, electronic medical records or survey data from either patient, plan or provider perspective using an average of 2.1 of 11 possible endpoints. A total of 68% of the studies reported the impact on plan focused endpoints, while the clinical, the patient or the provider perspective were studied to a much lower degree (45%, 42% and 12% of the studies). Health outcomes were only accounted for in 9.2% of the studies.</p> <p>Conclusion</p> <p>Comprehensive assessment of quality considering plan, patient and clinical outcomes is not yet applied. There is no defined quality standard. Benchmarks including health outcomes should be determined and used to improve the overall clinical and economic effectiveness of drug management programs.</p

Essential medicines in universal health coverage : a scoping review of public health law interventions and how they are measured in five middle-income countries

Very few studies exist of legal interventions (national laws) for essential medicines as part of universal health coverage in middle-income countries, or how the effect of these laws is measured. This study aims to critically assess whether laws related to universal health coverage use five objectives of public health law to promote medicines affordability and financing, and to understand how access to medicines achieved through these laws is measured. This comparative case study of five middle-income countries (Ecuador, Ghana, Philippines, South Africa, Ukraine) uses a public health law framework to guide the content analysis of national laws and the scoping review of empirical evidence for measuring access to medicines. Sixty laws were included. All countries write into national law: (a) health equity objectives, (b) remedies for users/patients and sanctions for some stakeholders, (c) economic policies and regulatory objectives for financing (except South Africa), pricing, and benefits selection (except South Africa), (d) information dissemination objectives (ex. for medicines prices (except Ghana)), and (e) public health infrastructure. The 17 studies included in the scoping review evaluate laws with economic policy and regulatory objectives (n = 14 articles), health equity (n = 10), information dissemination (n = 3), infrastructure (n = 2), and sanctions (n = 1) (not mutually exclusive). Cross-sectional descriptive designs (n = 8 articles) and time series analyses (n = 5) were the most frequent designs. Change in patients' spending on medicines was the most frequent outcome measure (n = 5). Although legal interventions for pharmaceuticals in middle-income countries commonly use all objectives of public health law, the intended and unintended effects of economic policies and regulation are most frequently investigated

Snapshot of Inter-Regional Cooperation for Basic Public Services in the Ajatappareng Area, Indonesia

Abstract The development of an inter-regional cooperation model in providing basic public services in the Ajatappareng area of South Sulawesi Province, Indonesia, is presumably not as effective as expected. This study aims to describe basic public services (health, education and transportation) and models or patterns of cooperation developed by local governments. This study used a survey�evaluative method. Data were collected using observation, interview and documentation techniques. Data were analyzed using descriptive analysis techniques and shift-share analysis. The result is a fairly effective provision of basic public services in education, health and transportation. The provision of effective education services is seen from the aspects of equal distribution and expansion of access, quality of services provided, internal efficiency and effectiveness of institutional management. Provision of health services is quite successful in terms of public access, equity and justice, public health status, and levels of mortality, morbidity and community nutritional status. The provision of transportation services is quite effective, seen from the provision of infrastructure that can open up regional access to remote areas. There are two models of inter-regional cooperation and coordination that are implemented, namely "service exchange" and "consolidation of service mergers", in addition to the three idealized cooperation models. The three service models that are not optimal in practice are inter-government service contracts, joint service agreements and permanent transfers of inter-regional government services

Uso de antihistamínicos para el tratamiento de urticaria aguda en niños menores de 6 años en Iquitos 2022

The incidence of urticaria in children ranges from 15% to 23% of the general population. Second-generation antihistamines are considered to be of choice because they are safe and have adequate efficacy in younger children. However, the management and treatment of acute urticaria still needs to be strengthened, since in practice there is still confusion about how to treat children in the short, medium and long term. Therefore, the present study considers: Objective: Evaluate the use of antihistamines in the treatment of acute urticaria in children under 6 years old at the Regional Hospital of Loreto, 2022. Materials and methods: Quantitative, analytical and cross-sectional study. The sample will be taken from 196 patients treated at the Regional Hospital of Loreto in the topic of emergency pediatrics with a diagnosis of urticaria who were prescribed antihistamines. The technique will be data collection through a simple collection form.La incidencia de urticaria en niños oscila entre el 15% y el 23% de la población general. Los antihistamínicos de segunda generación son considerados de elección por tener considerarse seguros y adecuada eficacia en niños menores. Sin embargo, el manejo y tratamiento de la urticaria aguda aun requiere ser fortalecido, puesto que en la práctica aún existe confusión sobre cómo tratar a los niños a corto, mediano y largo plazo. Por lo cual, el presente estudio se plantea: Objetivo:Evaluar el uso de antihistamínicos en el tratamiento de urticaria aguda de niños menores de 6 años en el Hospital Regional de Loreto, 2022. Materiales y métodos: Estudio cuantitativo, analítico y transversal. Se tomará como muestra a 196 historias de pacientes atendidos en el Hospital Regional de Loreto en el tópico de pediatría de emergencia con diagnóstico de urticaria a quienes se le prescribieron antihistamínicos. La técnica será la recolección de datos por medio de una ficha de recolección simple

The impact of cost containment reforms to the Pharmaceutical Benefits Scheme (PBS) on prescribing volumes and expenditure in Australia: 1992-2011

Objectives: To investigate the impact of cost containment measures on PBS prescribing volumes and expenditure. Methods: Segmented linear regression models were used to analyse the time series data from Medicare Australia’s PBS Statistics. Seven measures and four new listing dates of statins were investigated. Results: Many of the cost containment measures were effective in containing costs. Conclusions: The safety net 20 days rule was estimated to be the most effective in reducing drugs utilisation and expenditure