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dc.contributor.authorMcCormick, Danny
dc.contributor.authorGurwitz, Jerry H.
dc.contributor.authorSavageau, Judith A.
dc.contributor.authorYarzebski, Jorge L.
dc.contributor.authorGore, Joel M.
dc.contributor.authorGoldberg, Robert J.
dc.date2022-08-11T08:08:35.000
dc.date.accessioned2022-08-23T16:00:23Z
dc.date.available2022-08-23T16:00:23Z
dc.date.issued1999-03-03
dc.date.submitted2008-06-12
dc.identifier.citationJ Gen Intern Med. 1999 Feb;14(2):73-81.
dc.identifier.issn0884-8734 (Print)
dc.identifier.pmid10051777
dc.identifier.urihttp://hdl.handle.net/20.500.14038/30871
dc.description.abstractOBJECTIVE: To assess the impact of fee-for-service (FFS) versus HMO medical insurance coverage on receipt of aspirin, beta-blockers, and calcium channel blockers at the time of hospital discharge following an acute myocardial infarction. DESIGN: Prospective, population-based study. SETTING: All 16 community and tertiary care hospitals in the metropolitan area of Worcester, Massachusetts. PATIENTS: The study population consisted of patients under 65 years of age hospitalized with a validated acute myocardial infarction in all hospitals in the Worcester (Massachusetts) Standard Metropolitan Statistical Area (1990 census estimate, 437,000) during 1986, 1988, 1990, 1991, and 1993. MEASUREMENTS AND MAIN RESULTS: After adjustment for demographic and clinical variables as well as study year, the odds ratios for receipt of each medication for patients with HMO insurance compared with FFS were 1.05 (95% confidence interval [CI] 0.77, 1.44) for aspirin, 1.32 (95% CI 0.98, 1.76) for beta-blockers, and 0.72 (95% CI 0.54, 0.96) for calcium channel blockers. Examination of temporal trends in utilization of these agents suggests that observed decreases in use of calcium channel blockers and increases in use of beta-blockers over the period under study occurred more rapidly for HMO than for FFS patients. CONCLUSIONS: Overall, use of aspirin and beta-blockers was comparable among HMO and FFS patients and use of calcium channel blockers (deemed less effective or ineffective for secondary prevention) was lower among HMO patients. Differential adoption, over time, of evidence-based prescribing practices for medications between HMO and FFS patients who have had a myocardial infarction warrants further study.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10051777&dopt=Abstract ">Link to article in PubMed</a>
dc.relation.urlhttp://search.ebscohost.com/login.aspx?direct=true&db=byh&AN=5527873&site=ehost-live
dc.subjectAdrenergic beta-Antagonists
dc.subjectAdult
dc.subjectAspirin
dc.subjectCalcium Channel Blockers
dc.subjectCardiovascular Agents
dc.subjectConfidence Intervals
dc.subjectDrug Utilization
dc.subjectFee-for-Service Plans
dc.subjectFemale
dc.subjectHealth Maintenance Organizations
dc.subjectHumans
dc.subjectMale
dc.subjectMassachusetts
dc.subjectMiddle Aged
dc.subjectMultivariate Analysis
dc.subjectMyocardial Infarction
dc.subjectOdds Ratio
dc.subjectPatient Discharge
dc.subjectPopulation Surveillance
dc.subjectProspective Studies
dc.subjectCardiovascular Diseases
dc.subjectCommunity Health
dc.subjectCommunity Health and Preventive Medicine
dc.subjectHealth Services Research
dc.subjectPreventive Medicine
dc.titleDifferences in discharge medication after acute myocardial infarction in patients with HMO and fee-for-service medical insurance
dc.typeArticle
dc.source.journaltitleJournal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine
dc.source.volume14
dc.source.issue2
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/fmch_articles/2
dc.identifier.contextkey523422
html.description.abstract<p>OBJECTIVE: To assess the impact of fee-for-service (FFS) versus HMO medical insurance coverage on receipt of aspirin, beta-blockers, and calcium channel blockers at the time of hospital discharge following an acute myocardial infarction.</p> <p>DESIGN: Prospective, population-based study.</p> <p>SETTING: All 16 community and tertiary care hospitals in the metropolitan area of Worcester, Massachusetts.</p> <p>PATIENTS: The study population consisted of patients under 65 years of age hospitalized with a validated acute myocardial infarction in all hospitals in the Worcester (Massachusetts) Standard Metropolitan Statistical Area (1990 census estimate, 437,000) during 1986, 1988, 1990, 1991, and 1993.</p> <p>MEASUREMENTS AND MAIN RESULTS: After adjustment for demographic and clinical variables as well as study year, the odds ratios for receipt of each medication for patients with HMO insurance compared with FFS were 1.05 (95% confidence interval [CI] 0.77, 1.44) for aspirin, 1.32 (95% CI 0.98, 1.76) for beta-blockers, and 0.72 (95% CI 0.54, 0.96) for calcium channel blockers. Examination of temporal trends in utilization of these agents suggests that observed decreases in use of calcium channel blockers and increases in use of beta-blockers over the period under study occurred more rapidly for HMO than for FFS patients.</p> <p>CONCLUSIONS: Overall, use of aspirin and beta-blockers was comparable among HMO and FFS patients and use of calcium channel blockers (deemed less effective or ineffective for secondary prevention) was lower among HMO patients. Differential adoption, over time, of evidence-based prescribing practices for medications between HMO and FFS patients who have had a myocardial infarction warrants further study.</p>
dc.identifier.submissionpathfmch_articles/2
dc.contributor.departmentDepartment of Medicine, Division of Geriatric Medicine
dc.contributor.departmentMeyers Primary Care Institute
dc.contributor.departmentDepartment of Medicine, Division of Cardiovascular Medicine
dc.contributor.departmentDepartment of Family Medicine and Community Health
dc.source.pages73-81


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