title: Potential health implications of racial and ethnic disparities in meeting MTM eligibility criteria.
abstract: BACKGROUND
  Previous studies have found that racial and ethnic minorities would be less likely to meet the Medicare eligibility criteria for medication therapy management (MTM) services than their non-Hispanic White counterparts.
  
  
  OBJECTIVE
  To examine whether racial and ethnic disparities in health status, health services utilization and costs, and medication utilization patterns among MTM-ineligible individuals differed from MTM-eligible individuals.
  
  
  METHODS
  This study analyzed Medicare beneficiaries in 2004-2005 Medicare Current Beneficiary Survey. Various multivariate regressions were employed depending on the nature of dependent variables. Interaction terms between the dummy variables for Blacks (and Hispanics) and MTM eligibility were included to test whether disparity patterns varied between MTM-ineligible and MTM-eligible individuals. Main and sensitivity analyses were conducted for MTM eligibility thresholds for 2006 and 2010.
  
  
  RESULTS
  Based on the main analysis for 2006 MTM eligibility criteria, the proportions for self-reported good health status for Whites and Blacks were 82.82% vs. 70.75%, respectively (difference = 12.07%; P < 0.001), among MTM-ineligible population; and 56.98% vs. 52.14%, respectively (difference = 4.84%; P = 0.31), among MTM-eligible population. The difference between these differences was 7.23% (P < 0.001). In the adjusted logistic regression, the interaction effect for Blacks and MTM eligibility had an OR of 1.57 (95% Confidence Interval, or CI = 0.98-2.52) on multiplicative term and difference in odds of 2.38 (95% CI = 1.54-3.22) on additive term. Analyses for disparities between Whites and Hispanics found similar disparity patterns. All analyses for 2006 and 2010 eligibility criteria generally reported similar patterns. Analyses of other measures did not find greater racial or ethnic disparities among the MTM-ineligible than MTM-eligible individuals.
  
  
  CONCLUSIONS
  Disparities in MTM eligibility may aggravate existing racial and ethnic disparities in health outcomes. However, disparities in MTM eligibility may not aggravate existing disparities in health services utilization and costs and medication utilization patterns. Future studies should examine the effects of Medicare Part D on these disparities.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN 38163, USA. Electronic address: jwang26@uthsc.edu.
authors.forename: Junling
authors.initials: J
authors.lastname: Wang
authors.forename: Yanru
authors.initials: Y
authors.lastname: Qiao
authors.forename: Ya-Chen
authors.initials: YC
authors.lastname: Tina Shih
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Wan
authors.forename: Shelley I
authors.initials: SI
authors.lastname: White-Means
authors.forename: Samuel
authors.initials: S
authors.lastname: Dagogo-Jack
authors.forename: William C
authors.initials: WC
authors.lastname: Cushman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D004608:Eligibility Determination; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D054539:Medication Therapy Management / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014481:United States; D044465:White People / Q000706:statistics & numerical data
keywords: Eligibility criteria; Ethnicity; Health disparities; Medication therapy management services; Race