Differences in discharge medication after acute myocardial infarction in patients with HMO and fee-for-service medical insurance.
OBJECTIVE
To assess the impact of fee-for-service (FFS) versus HMO medical insurance coverage on receipt of aspirin, beta-blockers, and calcium channel blockers at the time of hospital discharge following an acute myocardial infarction.


METHODS
Prospective, population-based study.


METHODS
All 16 community and tertiary care hospitals in the metropolitan area of Worcester, Massachusetts.


METHODS
The study population consisted of patients under 65 years of age hospitalized with a validated acute myocardial infarction in all hospitals in the Worcester (Massachusetts) Standard Metropolitan Statistical Area (1990 census estimate, 437,000) during 1986, 1988, 1990, 1991, and 1993.


RESULTS
After adjustment for demographic and clinical variables as well as study year, the odds ratios for receipt of each medication for patients with HMO insurance compared with FFS were 1.05 (95% confidence interval [CI] 0.77, 1.44) for aspirin, 1.32 (95% CI 0.98, 1.76) for beta-blockers, and 0.72 (95% CI 0.54, 0.96) for calcium channel blockers. Examination of temporal trends in utilization of these agents suggests that observed decreases in use of calcium channel blockers and increases in use of beta-blockers over the period under study occurred more rapidly for HMO than for FFS patients.


CONCLUSIONS
Overall, use of aspirin and beta-blockers was comparable among HMO and FFS patients and use of calcium channel blockers (deemed less effective or ineffective for secondary prevention) was lower among HMO patients. Differential adoption, over time, of evidence-based prescribing practices for medications between HMO and FFS patients who have had a myocardial infarction warrants further study.
McCormick
D
D
Section for Health Services Research, Division of General Medicine/Primary Care/Geriatrics, University of Massachusetts Medical School, Worcester 01655, USA.
Gurwitz
J H
JH
Savageau
J
J
Yarzebski
J
J
Gore
J M
JM
Goldberg
R J
RJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000145:classification* / Q000627:therapeutic use*; D016001:Confidence Intervals; D004363:Drug Utilization; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy*; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D011159:Population Surveillance; D011446:Prospective Studies
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D001241:Aspirin