Rural/Urban Disparities in Utilization of Diabetes Self-Management Training to the Fee-for-Service Medicare Population

Overview of Key Findings In 2016, rural fee-for-service (FFS) Medicare beneficiaries represented 21.7% of the population diagnosed with diabetes, but only 2.7% of the population utilizing Diabetes Self-Management Training. Utilization of DSMT services in 2016 occurred in 76 rural counties and 309 urban counties. Average utilization rates of DSMT services were greater in rural counties than urban counties (5.5% vs. 2.5%)

Rural/Urban Disparities in the Utilization of Health and Behavioral Assessments/Interventions in the Fee-for-Service Medicare Population

Overview of Key Findings In 2016, rural county residents represented 21.8% of the fee-for-service (FFS) Medicare population, but only 1.6% of rural FFS beneficiaries live in a county with local utilization of Health and Behavioral Assessments and Interventions (HBAI) services. Utilization of HBAI services in 2016 occurred in 19 (9.7%) rural counties and 176 (90.3%) urban counties. Average utilization rates of HBAI services were higher in rural counties than urban counties (0.7% vs. 0.4%)

Rural/Urban Disparities in Utilization of Medical Nutrition Therapy to the Fee-for-Service Medicare Population

Overview of Key Findings In 2016, 21.8% of the fee-for-service (FFS) Medicare population resided in a rural county, but only 3.7% of enrollees residing in a county with utilization of Medical Nutrition Therapy (MNT) services were rural county residents. Utilization of MNT services in 2016 occurred in 92 rural counties and 388 urban counties. Average utilization rates of MNT services were greater in rural counties than urban counties (3.1% vs. 1.9%)

A Tale of Two Cities? The Heterogeneous Impact of Medicaid Managed Care

Evaluating Accountable Care Organizations is difficult because there is a great deal of heterogeneity in terms of their reimbursement incentives and other programmatic features. We examine how variation in reimbursement incentives and administration among two Medicaid managed care plans impacts uti- lization and spending. We use a quasi-experimental approach exploiting the timing and county-specific implementation of Medicaid managed care mandates in two contiguous regions of Kentucky. We find large differences in the relative success of each plan in reducing utilization and spending that are likely driven by important differences in plan design. The plan that capitated primary care physicians and contracted out many administrative responsibilities to an experienced managed care organization achieved significant reductions in outpatient and professional utilization. The plan that opted for a fee-for-service reimbursement scheme with a group withhold and handled administration internally saw a much more modest reduction in outpatient utilization and an increase in professional utilization

Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population

Overview of Key Findings In 2014, the overall mean vaccination rate in urban areas was 4.66 compared to a mean vaccination rate of 2.81 in rural areas, indicating a 40% lower mean vaccination rate in rural communities. The majority of pneumococcal vaccine services delivered to fee-for-service Medicare beneficiaries were provided by primary care providers, although pharmacy providers delivered close to one-fourth (22.2%) of these services. The proportion of pneumococcal vaccine services delivered by pharmacy providers was significantly greater in rural versus urban counties (29.4% vs. 21.1%). Consistent with previous literature, county characteristics positively associated with pneumococcal vaccine service delivery include increasing age of residents, more female residents, and availability of inpatient hospital services, while rurality, poverty, and greater overall health status were negatively associated with delivery of pneumococcal vaccine services

Utilization of Free Medication Samples in the United States in a Nationally Representative Sample: 2009-2013

Background—Manufacturers provide free sample medications as a means to increase use of branded medications. Sample use varies year-to-year as branded product patents expire and new products come to market. Objective—This study sought to describe the use of sample medications during 2009–2013 and assess individual characteristics associated with sample use. Methods—Data from the 2009–2013 U.S. Medical Expenditure Panel Survey (MEPS) were used. MEPS asks participants whether they received each medication they are taking as a sample. The top 10 medications and medication classes used each year by volume were identified as well as the proportion of people who used at least one sample medication. The proportion of new initiators of medications were also classified as the percent who received a sample for the specific medication. Logistic regression was used to assess individual demographics, insurance, and medication characteristics associated with use. Results—Prevalence of sample use ranged from 9.3% in 2009 to 6.2% in 2013. The most widely used sample medications included statins during 2009–2011, which changed to inhaled β-agonists in 2012–2013, as atorvastatin became available as a generic. The overall volume of the top 10 free sample medications decreased by one-third over this study period. In 2013, 12.6% of new insulin analog users and 11.0% of new oral contraceptive users receive these medications through samples. Regression analysis showed that U.S. Medicaid- and Medicare-insured persons were less likely to use samples compared to those with private insurance. Conclusions—Sample medication use has decreased as generic medications are becoming more used in the U.S

National Trends in Off-Label Use of Atypical Antipsychotics in Children and Adolescents in the United States

The objectives of the study were as follows: to examine the national trend of pediatric atypical antipsychotic (AAP) use in the United States; to identify primary mental disorders associated with AAPs; to estimate the strength of independent associations between patient/provider characteristics and AAP use. Data are from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. First, average AAP prescription rates among 4 and 18-year-old patients between 1993 and 2010 were estimated. Second, data from 2007 to 2010 were combined and analyzed to identify primary mental disorders related to AAP prescription. Third, a multivariate logistic regression model was developed having the presence of AAP prescription as the dependent variable and patient/provider characteristics as explanatory variables. Adjusted odds ratios (AORs) with associated 95% confidence intervals (CIs) were estimated. Outpatient visits including an AAP prescription among 4 to 18-year-old patients significantly increased between 1993 and 2010 in the United States, and over 65% of those visits did not have diagnoses for US Food and Drug Administration-approved AAP indications. During 2007 to 2010, the most common mental disorder was attention-deficit hyperactivity disorder, accounting for 24% of total pediatric AAP visits. Among visits with attention-deficit hyperactivity disorder diagnosis, those with Medicaid as payer (AOR 1.66, 95% CI 1.01–2.75), comorbid mental disorders (e.g., psychoses AOR 3.34, 95% CI 1.35–8.26), and multiple prescriptions (4 or more prescriptions AOR 4.48, 95% CI 2.08–9.64) were more likely to have an AAP prescription. The off-label use of AAPs in children and adolescents is prevalent in the United States. Our study raises questions about the potential misuse of AAPs in the population

The Prevalence and Predictors of Low-Cost Generic Program Use in a Nationally Representative Uninsured Population

The uninsured population has much to gain from affordable sources of prescription medications. No prior studies have assessed the prevalence and predictors of low-cost generic drug programs (LCGP) use in the uninsured population in the United States. A cross-sectional study was conducted using data from the Medical Expenditure Panel Survey (MEPS) during 2007–2012 including individuals aged 18 and older who were uninsured for the entire 2-year period they were in MEPS. The proportions of LCGP fills and users was tracked each year and logistic regression was used to assess significant factors associated with LCGP use. A total of 8.3 million uninsured individuals were represented by the sample and 39.9% of these used an LCGP. Differences between users and non-users included higher age, gender, year of participation, and number of medications filled. The proportion of fills and users via LCGPs increased over the 2007–2012 study period. Healthcare providers, especially pharmacists, should make uninsured patients aware of this source of affordable medications