Kamal-Bahl S, Stuart B, Briesacher B; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 23.
Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, 506 W. Fayette, St., Room 113,, Baltimore,, MD 21201; Tel: (410) 706-2747; Fax: (410) 706-1488; E-mail: skama001@umaryland.edu
RESEARCH OBJECTIVE: Although propoxyphene is generally considered inappropriate for the elderly, there is still evidence of its widespread use. This study examines prevalence of propoxyphene use among elderly Medicare beneficiaries between 1993 and 1998 and identifies the person-level factors associated with exposure to the drug. STUDY DESIGN: The study used data from the Medicare Current Beneficiary Cost and Use Survey (MCBS) from 1993 through 1998. The MCBS is a longitudinal panel survey that is designed to be nationally representative and it captures demographic, health status, health care use and expenditures for Medicare beneficiaries. Prescription drug utilization data in the MCBS are based on self-reports of prescriptions filled during the year. Population-level annual prevalence rates for propoxyphene users were computed for each year. A logistic regression was conducted using 1998 data and the dependent variable was defined as the likelihood of propoxyphene use. Explanatory variables captured individual characteristics, health status, chronic conditions and geographic residence. POPULATION STUDIED: Approximately 8,000 to 10,000 community-dwelling elderly Medicare beneficiaries in each annual MCBS survey for years 1993-1998 (weighted n = approximately 27 to 33 million beneficiaries per year). PRINCIPAL FINDINGS: Annual prevalence of propoxyphene use among all elderly beneficiaries ranged from 7.0% (1993) to 6.8% (1998), peaking at 7.5% in 1994. The actual number of beneficiaries exposed to propoxyphene in each year was approximately 2 million. Logistic regression results indicate females had 40% higher odds of receiving propoxyphene. Beneficiaries in poor health (OR, 2.5; 95%CI, 1.7-3.6) and fair health (OR, 1.6; 95%CI, 1.1-2.3) were more likely to take propoxyphene than beneficiaries in excellent health. Propoxyphene use was also more likely in beneficiaries reporting arthritis (OR, 2.0; CI, 1.6-2.5), pain (OR, 1.6; 95%CI 1.2-2.2), and osteoporosis (OR, 1.4; 95%CI 1.2-1.7). Beneficiaries residing in the Midwest (OR, 1.8; 95%CI, 1.3-2.5) and South (OR, 1.9; 95%CI, 1.4-2.5) were nearly twice as likely to receive propoxyphene compared to the beneficiaries in the East. The odds were significantly higher for beneficiaries residing in rural areas. Having Medicaid drug coverage increased the likelihood of receiving propoxyphene (OR, 1.4; 95%CI, 1.1-1.8) as compared to those with no drug coverage. CONCLUSIONS: Prevalence rates of propoxyphene use in the elderly Medicare beneficiaries have been high and relatively stable between 1993 and 1998. There exist clear geographic variations in the extent of use of this drug, which would appear to reflect distinct differences in practice patterns. Beneficiaries in vulnerable health are more likely to be exposed to this potentially inappropriate agent. Furthermore, use of propoxyphene in beneficiaries with conditions such as arthritis and pain is also of high concern given that relatively safer and equally efficacious substitutes to propoxyphene are available. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The consistent use of an older drug product considered inappropriate in this population inspite of availability of newer and better products demonstrates the unchanging drug prescribing habits over time. Appropriate educational interventions need to be designed to reduce prescribing of propoxyphene in the vulnerable elders.
Publication Types:
Keywords:
- Aged
- Data Collection
- Dextropropoxyphene
- Drug Utilization
- Female
- Health Expenditures
- Health Services Needs and Demand
- Health Status
- Humans
- Longitudinal Studies
- Medicaid
- Medicare
- Pharmaceutical Preparations
- Prescriptions, Drug
- Prevalence
- Residence Characteristics
- economics
- epidemiology
- utilization
- hsrmtgs
Other ID:
UI: 102274223
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