Journal ArticleDOI
Medicaid prescription drug policies and medication access and continuity: findings from ten states.
Joyce C. West,Joshua E. Wilk,Donald S. Rae,Irvin S. Muszynski,Maritza Rubio Stipec,Carol L. Alter,Karen E. Sanders,Stephen Crystal,Darrel A. Regier +8 more
TLDR
It is indicated that more effective Medicaid prescription drug management and financing practices are needed to promote medication continuity and improve treatment outcomes.Abstract:
Objectives: The aims of this study were to compare medication access problems among psychiatric patients in ten state Medicaid programs, assess adverse events associated with medication access problems, and determine whether prescription drug utilization management is associated with access problems and adverse events. Methods: Psychiatrists from the American Medical Association’s Masterfile were randomly selected (N=4,866). Sixty-two percent responded; 32% treated Medicaid patients and were randomly assigned a start day and time to report on two Medicaid patients (N=1,625 patients). Results: A medication access problem in the past year was reported for a mean±SE of 48.3%±2.0% of the patients, with a 37.6% absolute difference between states with the lowest and highest rates (p<.001). The most common access problems were not being able to access clinically indicated medication refills or new prescriptions because Medicaid would not cover or approve them (34.0%±1.9%), prescribing a medication not clinically preferred because clinically indicated or preferred medications were not covered or approved (29.4%±1.8%), and discontinuing medications as a result of prescription drug coverage or management issues (25.8%±1.6%). With patient case mix adjusted to control for sociodemographic and clinical confounders, patients with medication access problems had 3.6 times greater likelihood of adverse events (p<.001), including emergency visits, hospitalizations, homelessness, suicidal ideation or behavior, or incarceration. Also, all prescription drug management features were significantly associated with increased medication access problems and adverse events (p<.001). States with more access problems had significantly higher adverse event rates (p<.001). Conclusions: These associations indicate that more effective Medicaid prescription drug management and financing practices are needed to promote medication continuity and improve treatment outcomes. (Psychiatric Services 60:601– 610, 2009)read more
Citations
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Journal ArticleDOI
Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities
Charlotte E. Hunter,Anita Palepu,Susan Farrell,Evie Gogosis,Kristen O’Brien,Stephen W. Hwang,Stephen W. Hwang +6 more
TL;DR: Homeless and vulnerably housed individuals face significant barriers to medication adherence and health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.
Journal ArticleDOI
Estimating the Impact of Adherence to and Persistence with Atypical Antipsychotic Therapy on Health Care Costs and Risk of Hospitalization
Yawen Jiang,Weiyi Ni +1 more
TL;DR: To estimate the impact of adherence to and persistence with atypical antipsychotics on health care costs and risk of hospitalization by controlling potential sources of endogeneity.
Journal ArticleDOI
Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans
TL;DR: In this paper, the authors investigated rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota and found that rural enrollees were more likely to report no past year preventive care compared to urban enrollees.
Journal ArticleDOI
Aftercare, emergency department visits, and readmission in adolescents.
Corine Carlisle,Corine Carlisle,Muhammad Mamdani,Muhammad Mamdani,Russell Schachar,Russell Schachar,Teresa To,Teresa To +7 more
TL;DR: It is found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit, which may indicate a relative lack of psychiatric services for youth.
Journal ArticleDOI
Reconceptualizing Medication Adherence: Six Phases of Dynamic Adherence
TL;DR: Changes in the concept of adherence are described, a more comprehensive definition of adherence is presented that recognizes the role of patient‐provider transactions, and dynamic adherence, a six‐phase model, is introduced, which incorporates therole of transactional processes and other factors that influence patients’ adherence decisions.
References
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Use of atypical antipsychotic drugs for schizophrenia in Maine Medicaid following a policy change.
Stephen B. Soumerai,Fang Zhang,Dennis Ross-Degnan,Daniel E. Ball,Robert F. LeCates,Michael R. Law,Tom E. Hughes,Daniel Chapman,Alyce S. Adams +8 more
TL;DR: More than one-third of Medicaid programs and Medicare Part D plans use prior authorization (PA) policies to control the use of atypical antipsychotics (AAs).
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Medicaid Cost Containment And Access To Prescription Drugs
TL;DR: The results show that enrollee in states that have implemented all or almost all of these five policies have greater problems getting prescription drugs than enrollees in other states encounter.
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Problems due to medication costs among VA and non-VA patients with chronic illnesses.
TL;DR: The VA's prescription benefits may prevent problems due to medication costs, and studies assessing the impact of VA prescription coverage on health outcomes and service use will be needed to evaluate the cost-effectiveness of VA drug benefit policies.
Journal ArticleDOI
Population-Based Disease Management Under Fee-For-Service Medicare
TL;DR: An overview of how PDM programs are evolving in the private sector is provided and how they differ from other approaches already being tested in Medicare disease management demonstrations is described.