Prescription analgesic and antidepressant utilization and cost among elderly Medicaid beneficiaries before and after nursing home admission.
OBJECTIVE
The objectives of this study were to describe changes in prescription analgesic and antidepressant medications and to track the costs associated with these medication changes when elderly Medicaid beneficiaries move from the community to a nursing home setting.


METHODS
Retrospective analysis of Medicaid long-term care and drugs claims data for fiscal year 2000 from three different states.


METHODS
Long-term care facilities in three different states.


METHODS
We studied 1321 elderly Medicaid beneficiaries newly admitted to a nursing home during the study period.


METHODS
Pain medications were grouped into four different categories and all antidepressants were grouped into one category. For each medication category, we obtained the number of unique patients for whom it was prescribed, the number of days it was prescribed, and the amount paid by Medicaid. We then calculated the percentage of subjects prescribed and the amount paid per day for each medication class before and after nursing home admission.


RESULTS
Except for skeletal muscle relaxants, 21% to 39% of beneficiaries already had claims linked to each medication class while still living in the community. After nursing home admission, the percentage of beneficiaries exposed to each medication class increased by 2% to 33%. Cost per day of therapy increased by 10% to 83%. There was significant variation among the states in utilization and cost per day of therapy.


CONCLUSIONS
We draw three major conclusions: (1) community-dwelling elderly Medicaid beneficiaries in this study use more prescription analgesics and antidepressants than community-dwelling elders in prior studies; (2) there is a significant increase in medication utilization and cost on nursing home admission; and (3) significant variability in medication use and cost exists among the three states examined. Further investigation to elucidate the reasons for these differences could assist legislators in formulating sound public policy to contain Medicaid expenditures without sacrificing patient care.
Department of Medicine, Division of Geriatrics, University of California at Los, Los Angeles School of Medicine, Los Angeles, CA 91335, USA. lchu@mednet.ucla.edu
Lily
L
Chu
John F
JF
Schnelle
Dan
D
Osterweil
D000368:Aged; D000700:Analgesics / Q000191:economics*; D000928:Antidepressive Agents / Q000191:economics*; D003153:Community Health Services / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
D000700:Analgesics; D000928:Antidepressive Agents