Conway E, Udow M, Lucas L, Wennberg JE, Wennberg D, Hetzel M; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 153.
Blue Cross Blue Shield of Michigan, 600 Lafayette East, Mail Code J740, Detroit, MI 48126, Phone: (313) 225-8299, Fax: (313) 225-0118, E-mail: econway@bcbsm.com
RESEARCH OBJECTIVE: Pharmaceuticals are the fastest growing component of health care utilization and expense. Little is known, however, about their geographic utilization patterns. This research describes prescribing and utilization patterns of two major drug classes in an insured pediatric population -- antibiotics and attention deficit hyperactivity disorder (ADHD) drugs. In particular, we were interested in knowing whether the utilization patterns are class specific or whether they vary systematically by community.STUDY DESIGN: We used data from Blue Cross Blue Shield of Michigan (BCBSM), a large commercial insurer with high market penetration. Enrollment and pharmacy claims data files were used. Using small area analysis techniques, we constructed denominator files by hospital service area (HSA) -- empirically derived geographic regions reflecting travel patterns for primary care. Numerator files were constructed from pharmacy claims. Using the NDC, all non-parenteral antibiotics and all ADHD drugs were grouped. Age and sex adjusted rates of antibiotic and ADHD drug use were calculated using indirect standardization. HSAs with fewer than 25 expected events were excluded.POPULATION STUDIED: Michigan pediatric residents with BCBSM coverage (traditional, PPO and POS) in 1997 who had pharmaceutical coverage.PRINCIPAL FINDINGS: In 1997, 46.4% of child BCBSM pharmacy members received one or more prescriptions for antibiotics. In the HSAs with the highest rate, 58.2% of children received one or more prescriptions; in the region with least prescribing, 31% received a prescription. Pediatric antibiotics were prescribed 1.9 times more frequently in the highest rate region of Michigan than in the lowest. There was considerable variation among HSAs in the kinds, as well as numbers, of antibiotics prescribed. In some HSAs, physicians were more likely to favor high cost antibiotics than their counterparts elsewhere. In 1997, 3.6% of child BCBSM pharmacy beneficiaries received one or more prescriptions for drugs to treat ADHD. In the HSA with the highest rate of such prescriptions, 6.3% of children received one or more prescriptions; in the region with the lowest rate, 1.6% received prescriptions. Prescriptions for ADHD drugs were prescribed 4.1 times more frequently in the highest rate region than in the lowest. There was no relationship between the utilization patterns for antibiotics and ADHD drugs across regions (R2 = 0.15).CONCLUSIONS: Prescribing of pediatric antibiotics and ADHD drugs varied significantly by HSA.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: This is the first statewide examination of small area variations in the use of prescription drugs. This is a timely examination, given the recent rise in health care costs, much of which is attributable to the increased use of new and costly prescription drugs. The Dartmouth Atlas of Health Care in Michigan was commissioned by BCBSM as a way to open a statewide discussion about the quality of health care. The atlas findings are being shared with communities throughout the state in hopes of developing a better understanding of variation in the use of health care services and working with communities to enhance the quality of health care. The Blues will work collaboratively with physicians, hospitals, employers, labor unions and consumers in this ongoing effort.PRIMARY FUNDING SOURCE: Blue Cross Blue Shield of Michigan
Publication Types:
Keywords:
- Anti-Bacterial Agents
- Attention Deficit Disorder with Hyperactivity
- Blue Cross Blue Shield Insurance Plans
- Child
- Health Care Costs
- Health Expenditures
- Humans
- Michigan
- Pharmaceutical Preparations
- Pharmacies
- Prescriptions, Drug
- Primary Health Care
- Residence Characteristics
- Substance-Related Disorders
- economics
- utilization
- hsrmtgs
Other ID:
UI: 102273462
From Meeting Abstracts