Racial and ethnic disparities in prescription coverage and medication use

This study compared drug coverage and prescription drug use by race and Hispanic ethnicity for Medicare beneficiaries with three chronic conditions: diabetes, hypertension, or heart disease. We found that among beneficiaries without any drug coverage black persons and Hispanics used 10 to 40 percent fewer medications, on average, than white persons with the same illness, and spent up to 60 percent less in total drug costs. Having drug coverage somewhat lessened these differences although the effect was consistent with only M + C prescription benefits. Substantially lower medication use remained for dually eligible black beneficiaries and Hispanics with employer-sponsored drug benefits

Cost-Benefit Analysis of Haemophilus Influenzae Type B Immunization in Korea

An economic evaluation of Haemophilus influenzae type b (Hib) immunization was conducted to examine whether Hib immunization should be included in the Korea's national immunization program. The costs and benefits included direct and indirect values and an estimation of the economic efficiency. We determined that a universal Hib immunization program in Korea would prevent 17 deaths and 280 invasive Hib cases. When we assumed the one Hib immunization cost as 26,000 won, the national Hib immunization would cost 34.6 billion won. Costs for various Hib diseases were estimated at 26.8 billion won (11.8 billion won from direct costs and 14.9 billion won from indirect costs). A benefit-cost ratio of 0.77 showed that the economic efficiency of the integration of Hib immunization in Korea is low because of the low incidence rate of Hib disease and high price of vaccine. However, if the Hib immunization cost decrease to less than 20,000 won, a benefit-cost ratio increase to 1.0 and above, integrating Hib immunization into the national immunization program with economic efficiency can be considered

No More Free Drug Samples?

Susan Chimonas and Jerome Kassirer argue that giving out “free” drug samples is not effective in improving drug access for the indigent, does not promote rational drug use, and raises the cost of care

Use of shrubs and tree fodders by nonruminants

In IDL-522

Renaissance of Suburban Shopping

This thesis interrogates Eastgate Mall in Christchurch, to develop a revived architectural design for the neglected shopping mall. Shoppers are becoming increasingly familiar with online shopping, with many now preferring this channel over the physical (Blázquez, 2014, p. 109). While shoppers are offered convenience and often a larger range of goods, malls now appear to be spaces solely for urgent shopping (Rouz, 2014, p. 1881). This has decreased footfall and lowered people’s tendency to appear in these spaces for recreational and non- economical purposes. Shopping malls like Eastgate are declining as the “centreless centrepieces of suburbs” that deny surrounding communities their diversity, and economic and cultural prosperity (Chavan et al., 2007, p. 59). This thesis argues that current architecture widely used in shopping malls is detrimental to retailers—particularly small local businesses. It acknowledges that retail spaces will no longer be solely for the sale of goods. Therefore, it proposes to enrich the showing and selling of experiences as a way to revive Eastgate Mall and further differentiate its physical retail spaces from those in the online channel. By enriching shoppers’ experiences, the mall can embody the contemporary culture of transience and immediacy that shift its retail spaces away from the static and one-dimensional to the multi-functional and hybrid. The proposed design aims to sever ties with traditional expectations of shopping malls, thereby conforming to the idea that,“[I]f closed spaces [ . . . ] truly perpetuate its society[, we must] look beyond the strictures of architectural form to understand the many attributes of what these spaces represent and what they can be” ( Jewell, 2016, p. 103). Overall, the research in response to the current stagnation of Eastgate and rising popularity of online shopping proposes an experiential mall design; it seeks to differentiate the physical from online retail spaces and contribute to fostering the sense of community that surrounding suburbs are strengthening.</p

Impact of second-generation antipsychotics on the use of antiparkinson agents in nursing homes and assisted-living facilities

BACKGROUND: It is not known whether the reduced risk of motor adverse effects with second-generation antipsychotics (SGAPs) translates into less use of antiparkinson drugs (APDs). OBJECTIVE: This study sought to estimate national rates of concomitant prescribing of APDs and antipsychotic drugs among elderly Medicare beneficiaries without Parkinson\u27s disease (PD) who were residing in institutional settings from 1997 to 2000, a period during which the use of SGAPs increased greatly. METHODS: This was a retrospective, cross-sectional, descriptive analysis using the Medicare Current Beneficiary Survey database. The population of interest was residents of nursing homes (NHs) and assisted-living facilities (ALFs) who received concomitant antipsychotic drugs and APDs but did not have PD. The primary objective of the study was to estimate the prevalence of concomitant APD and antipsychotic drug use for each study year, by use of first-generation antipsychotics (FGAPs) and SGAPs in each setting. A secondary objective was to compare concomitant use of APDs and individual antipsychotic agents (ie, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, haloperidol, and thioridazine). We computed population-level annual prevalence rates for APD use and tested for statistically significant differences in APD use between FGAPs and SGAPs at the 5% significance level. RESULTS: In NH residents, concomitant use of APDs and antipsychotics decreased from 20.7% in 1997 to 9.0% in 2000 (P \u3c 0.005). APD use in NH residents declined similarly among users of FGAPs (from 23.2% in 1997 to 13.3% in 2000; P \u3c 0.005) and SGAPs (from 18.4% in 1997 to 8.1% in 2000; P \u3c 0.005). In ALF residents, concomitant use of APDs and antipsychotics decreased from 24.5% in 1997 to 21.1% in 2000 (P \u3c 0.005). ADP use in ALF residents receiving FGAPs decreased from 26.9% in 1997 to 24.2% in 2000 (P \u3c 0.005); there was no significant change in ADP use among ALF residents receiving SGAPs (from 21.0% in 1997 to 21.7% in 2000). CONCLUSIONS: These results provide the first nationally representative estimate of the concomitant use of APDs and antipsychotic drugs among older individuals in long-term care settings. The decrease in concomitant use of APDs and antipsychotics when SGAPs were used in NHs suggests an association between the use of SGAPs and a reduction in the prescribing cascade, in which one drug is used to treat the adverse effects of another. The results also suggest that some Medicare beneficiaries in ALFs may be continued on APDs despite changes in the prescribing of antipsychotic agents, implying a need for better medication-management practices in these institutions

Exploring racial and ethnic disparities in prescription drug spending and use among Medicare beneficiaries

BACKGROUND: Little is known about why minority Medicare beneficiaries spend less on and use fewer prescription drugs than white Medicare beneficiaries. OBJECTIVE: We explored whether population differences in demographic characteristics, socioeconomic status, and health status were associated with observed disparities by race and ethnicity in the prescription drug spending and use of noninstitutionalized elderly Medicare beneficiaries. METHODS: We used a nationally representative sample of 8101 white, 816 black, and 642 Hispanic Medicare beneficiaries from the 1999 Medicare Current Beneficiary Survey Cost and Use files. For each of these groups, we calculated total prescription drug spending, out-of-pocket spending, and number of prescriptions. We then used the Oaxaca-Blinder decomposition method to separate the impact of race and ethnicity on disparities in spending and use from the impact of differences in population characteristics across racial and ethnic groups. RESULTS: Much of the disparity in spending between whites and blacks and some of the disparity between whites and Hispanics can be attributed to race/ethnicity. Because of race/ethnicity, total spending for whites was 8.9% more than for blacks and 5.4% more than for Hispanics. Similarly, total out-of pocket spending for whites was 28.8% more than for blacks and 10.7% more than for Hispanics. Race/ethnicity also influenced the amount of prescription drug use. Whites used 2.3 more prescriptions than blacks and 1.6 more than Hispanics. However, these differences in use were offset by the impact of differences in population characteristics. CONCLUSIONS: Differences in factors identified in the Andersen model of access to care do not fully explain observed disparities in prescription drug use and spending. The portion of the disparities due to race and ethnicity may reflect patients\u27 skepticism about medicine and medical care in general, patients\u27 adherence to medical advice, patient-physician communication, physicians\u27 prescribing habits, and usual source of care. Future research should explore whether these and other unobserved factors associated with race and ethnicity are responsible for disparities in drug spending and use