title: Racial differences in switching, augmentation, and titration of lipid-lowering agents by Medicare/Medicaid dual-eligible patients.
abstract: OBJECTIVE
  The goal of this study was to examine prescription fill patterns of lipid-lowering agents among Medicare/ Medicaid dual-eligible patients by ethnicity.
  
  
  METHODS
  Study data were obtained from the Thomson Medstat MarketScan Medicaid claims database. Medicare/Medicaid beneficiaries who filled prescriptions for lipid-lowering agents during 2003 were included in the study. Logistic regression models estimated the probability that beneficiaries, by ethnicity, switched to a different lipid-lowering medication, augmented therapy with another lipid-lowering agent, or titrated the dosage of the drug upward over the course of the year.
  
  
  RESULTS
  The models revealed that African Americans were less likely to switch lipid-lowering agents (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.60-0.78), augment lipid-lowering agents (OR, 0.53; 95% CI, 0.43-0.66), or titrate upward (OR, 0.75; 95% CI, 0.67-0.84) than whites.
  
  
  CONCLUSIONS
  These results suggest that African Americans may be receiving less aggressive treatment than other patients, which in turn may explain why many studies find that African Americans are less likely to reach lipid goals. These treatment disparities merit further study, because they may impact dual-eligible patients moving into Medicare Part D plans.
authors.forename: Tami L
authors.initials: TL
authors.lastname: Mark
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Axelsen
authors.forename: Lisa
authors.initials: L
authors.lastname: Mucha
authors.forename: Yelena
authors.initials: Y
authors.lastname: Sadkova
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy / Q000208:ethnology*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000208:ethnology; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000960:Hypolipidemic Agents