title: Predictors of high-risk prescribing among elderly Medicare Advantage beneficiaries.
abstract: OBJECTIVE
  To examine patient, community, and insurance plan predictors of high-risk prescribing in the elderly Medicare Advantage population.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Using a sample of 203 Medicare Advantage plans from the 2006-2008 Health Outcomes Survey, we compared patient, community, and insurance plan characteristics of 77,247 respondents with and without new Medicare Part D claims for high-risk medications from June 2006 to May 2007.
  
  
  RESULTS
  Of the Medicare Advantage enrollee respondents, 15.6% received a new prescription for a high-risk medication during 12 months of follow-up. In adjusted analyses, new users of high-risk medications were more likely to be women (OR = 1.35; 95% CI,1.28-1.42), and they reported poorer general health (Physical Component Summary score 37.3 vs 40.4, P <.05) than did individuals who never received a high-risk prescription. Being aged ≥ 85 years was protective against receipt of a high-risk medication (OR relative to persons aged 65-69 years = 0.69; 95% CI, 0.64-0.75). Incidence of high-risk prescribing varied by census division, with a 2-fold difference between regions with the lowest and highest rates (9% in New England vs 18% in the West South Central region). Muscle relaxants, antihistamines, and opiates accounted for over 71% of new dispensing of high-risk medications. Approximately 67% of new users of high-risk medications received only 1 dispensing.
  
  
  CONCLUSIONS
  High-risk prescribing varies widely by geography and drug class in the Medicare Advantage population. Women, persons with poorer self-reported health, and those residing in the Southern regions of the United States more frequently receive high-risk medications. Variations may highlight areas for targeted interventions to reduce high-risk prescribing to the elderly.
authors.forename: Alicia L
authors.initials: AL
authors.lastname: Cooper
authors.forename: David D
authors.initials: DD
authors.lastname: Dore
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.affiliation: Department of Health Services, Policy and Practice, Brown University, Box G-S121-6, Providence, RI 02912. E-mail: amal_trivedi@brown.edu.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D020398:Medicare Part C / Q000706:statistics & numerical data*; D054524:Medicare Part D / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D014481:United States
chemical_list: D055553:Prescription Drugs