Health care and medication costs and use among older adults with heart failure.
BACKGROUND
Heart failure disproportionately affects older adults for whom multiple medications are prescribed to prevent exacerbations and hospitalization. To target interventions effectively, it is important to understand the association of medication acquisition with health care utilization and costs.


METHODS
We used electronic medical records from an urban public health care system to identify patients aged >/=50 years who had a diagnosis of heart failure. We assessed the association between inappropriate or appropriate medication supplies and hospitalization and costs using multivariable analyses that adjusted for demographic characteristics, prior health care use, health status, and insurance status.


RESULTS
Total health care costs for treating 1554 patients with heart failure from 1996 to 2000 were 36.6 million dollars (in 2000 dollars). Less than a third of patients received appropriate medication supplies (between 90% and 110% of the supplies needed) annually. Compared with patients with appropriate supplies, the odds of hospitalization were greater among those with undersupplies (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 2.3 to 4.2; P <0.0001) or oversupplies (OR = 2.0; 95% CI: 1.7 to 2.4; P <0.0001). Total costs were 25% higher for patients with undersupplies (95% CI: 8% to 46%; P = 0.004) and 18% higher for those with oversupplies (95% CI: 7% to 30%; P = 0.0009) than for those with appropriate supplies.


CONCLUSIONS
Among adults with heart failure, inappropriate medication supplies were associated with increased hospitalization and higher costs. Monitoring medication supplies from electronic medical records may be a useful component of programs aiming to improve care while managing costs.
Stroupe
Kevin T
KT
Midwest Center for Health Services and Policy Research, Hines VA Hospital, Illinois 60141-5151, USA. Stroupe@research.hines.med.va.gov
Teal
Evgenia Y
EY
Weiner
Michael
M
Gradus-Pizlo
Irmina
I
Brater
D Craig
DC
Murray
Michael D
MD
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000191:economics / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000191:economics* / Q000627:therapeutic use*; D004232:Diuretics / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011945:Receptors, Angiotensin / Q000627:therapeutic use; D012307:Risk Factors; D014504:Urban Health
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D002317:Cardiovascular Agents; D004232:Diuretics; D011945:Receptors, Angiotensin