Prescription drug benefits and use of guideline recommended medications by elderly Medicare beneficiaries with diabetes mellitus.
OBJECTIVE
To determine whether prescription drug benefits are associated with the use of guideline recommended medications by older persons with type 2 diabetes mellitus (DM).


METHODS
Cross-sectional study.


METHODS
A national sample of Medicare beneficiaries with DM aged 65 and older and an indication for angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II-receptor blocker (ARB) use or high risk of coronary heart disease (hypertension or current smoking) who participated in the 2003 Medicare Current Beneficiary Survey.


METHODS
Prescription drug coverage was measured according to self-report and verified according to insurance claims. Outcome variables were use of an ACEI or an ARB (ACEI/ARB) or a statin or use of an ACEI/ARB and a statin. Survey-weighted multinomial logistic regression was used to identify the independent effect of drug coverage on one of two categories of recommended medication use (ACEI/ARB or statin or ACEI/ARB and statin) compared with the reference category of none after controlling for sociodemographic characteristics and health status.


RESULTS
The final study sample was 1,181 (weighted N=4.0 million). Overall, 23% had no drug coverage, 16% Medicaid coverage, 43% employer coverage, 9% Medigap coverage, and 9% Department of Veterans Affairs (VA) or state-sponsored low-income coverage. Overall, 33% received a statin and an ACEI/ARB, 44% only an ACEI/ARB or a statin, and 23% neither. After adjustment, VA and state-sponsored drug benefits were most strongly associated with combined ACEI/ARB and statin use (relative risk ratio (RRR)=4.83, 95% confidence interval (CI)=2.24-10.4)), followed by employer-sponsored coverage (RRR=2.60, 95% CI=1.67-4.03)).


CONCLUSIONS
Prescription drug benefits from VA and state-sponsored drug programs are strongly associated with use of recommended medications by older adults with DM.
Tjia
Jennifer
J
Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA. jennifer.tjia@umassmed.edu
Briesacher
Becky A
BA
D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006264:Health Benefit Plans, Employee; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D019458:Insurance Coverage; D017054:Insurance, Medigap; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008484:Medicaid; D006278:Medicare; D017410:Practice Guidelines as Topic; D014481:United States; D014493:United States Department of Veterans Affairs
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
JAMA. 2004 Apr 21;291(15):1864-70
15100205
J Gen Intern Med. 2004 Jan;19(1):28-35
14748857
Diabetes Care. 2006 Mar;29(3):725-31
16505540
Am J Cardiol. 1997 Nov 15;80(10):1345-7
9388112
Health Care Financ Rev. 1997 Spring;18(3):211-29
10170350
Health Care Financ Rev. 1994 Summer;15(4):153-63
10138483
Lancet. 2000 Jan 22;355(9200):253-9
10675071
J Am Geriatr Soc. 2003 May;51(5):665-70
12752842
Health Serv Res. 2007 Jun;42(3 Pt 1):933-49
17489897
Ann Intern Med. 2004 Aug 17;141(4):272-81
15313743
JAMA. 2001 Oct 10;286(14):1732-9
11594898
JAMA. 1997 Jan 8;277(2):115-21
8990335
Health Aff (Millwood). 2007 Nov-Dec;26(6):1683-91
17978387
Diabetes Care. 2007 Jan;30 Suppl 1:S4-S41
17192377
Diabetes Care. 2007 Jun;30(6):1448-53
17337497
Am J Kidney Dis. 2005 Dec;46(6):1080-7
16310574
Health Aff (Millwood). 2007 Jan-Feb;26(1):w1-12
17118944
Diabetes Care. 2003 Jan;26 Suppl 1:S33-50
12502618
JAMA. 1993 Oct 20;270(15):1832-6
8411527
JAMA. 2001 May 16;285(19):2486-97
11368702
Med Care. 2000 Feb;38(2):131-40
10659687