title: Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program.
abstract: Adverse drug reactions and inappropriate prescribing practices are an important cause of hospitalization, morbidity, and mortality in the elderly. This study compares prescribing practices within a Medicare risk contract health maintenance organization (HMO) in 1993 and 1994 with prescribing practices for two nationally representative samples of elderly individuals predominantly receiving medical care within the Medicare fee-for-service sector. Information on prescriptions in the fee-for-service sector came from the 1987 National Medical Expenditures Survey (NMES) and the 1992 Medicare Current Beneficiary Survey (MCBS). A total of 20 drugs were studied; these drugs were deemed inappropriate for the elderly because their risk of causing adverse events exceeded their health benefits, according to a consensus panel of experts in geriatrics and pharmacology. One or more of the 20 potentially inappropriate drugs was prescribed to 11.53% of the Medicare HMO members in 1994. These medications were prescribed significantly less often to HMO members in 1994 than to individuals in the fee-for-service sector, based on information from both the 1987 NMES and the 1992 MCBS. Utilization of unsafe or ineffective medications actually decreased with increasing age in the HMO sample, with lowest rates in individuals over the age of 85. However, no relationship between age and medication use was seen in the NMES study, except for individuals over the age of 90 years. The study data support the conclusion that ineffective or unsafe medications were prescribed less often in the Medicare HMO than in national comparison groups. In fact, for the very old, who are most at risk, the use of these medications was much lower in the Medicare HMO than in the Medicare fee-for-service sector. Nevertheless, in 1994, approximately one of every nine members of this Medicare HMO received at least one such medication. Continued efforts and innovative strategies to further reduce the use of unsafe and ineffective drugs among elderly Medicare HMO members are needed.
authors.affiliation: NYLCare Health Plans, New York, NY 10006, USA.
authors.forename: R
authors.initials: R
authors.lastname: Futterman
authors.forename: H
authors.initials: H
authors.lastname: Fillit
authors.forename: J L
authors.initials: JL
authors.lastname: Roglieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002204:Capitation Fee; D011307:Drug Prescriptions; D004358:Drug Therapy / Q000592:standards*; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions; D018588:Fee-for-Service Plans / Q000592:standards*; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000191:economics / Q000592:standards*; D006801:Humans; D006278:Medicare / Q000458:organization & administration; D009519:New York City; D010818:Practice Patterns, Physicians'; D014481:United States