Medicare part D's exclusion of benzodiazepines and fracture risk in nursing homes
UMass Chan Affiliations
Department of Medicine, Division of Geriatric MedicineMeyers Primary Care Institute
Document Type
Journal ArticlePublication Date
2010-04-28Keywords
Accidental FallsAged
Aged, 80 and over
Anti-Anxiety Agents
Benzodiazepines
Cohort Studies
Confidence Intervals
Drug Utilization
Female
Hip Fractures
*Homes for the Aged
Humans
Incidence
Insurance Coverage
Legislation, Drug
Longitudinal Studies
Male
Medicare Part D
Multivariate Analysis
*Nursing Homes
Proportional Hazards Models
Reference Values
Risk Assessment
United States
Geriatrics
Health Services Research
Primary Care
Metadata
Show full item recordAbstract
BACKGROUND: Medicare Part D excludes benzodiazepine medications from coverage, and some state Medicaid programs also limit coverage. We assessed whether such policies decrease the risk of fractures in elderly individuals living in nursing homes. METHODS: This is a quasi-experimental study with interrupted time-series estimation and extended Cox proportional hazards models comparing changes in outcomes before and after implementation of Medicare Part D in a nationwide sample of nursing home residents in 48 states. The study included 1 068 104 residents and a subsample of 50 874 residents with fracture data from 1 pharmacy. We assessed monthly prescribing rates of benzodiazepines and potential substitutes from January 1, 2005, through June 30, 2007, and hazard ratios for incident hip fracture and falls, adjusted for age, sex, and race/ethnicity. Estimates were stratified by concurrent Medicaid limits on benzodiazepines: no supplemental coverage (1 state), partial supplemental coverage (6 states), or complete supplemental coverage (41 states). RESULTS: The no-supplemental-coverage policyresulted in an immediate and significant reduction of 10 absolute points in benzodiazepine use (27.0% to 17.0%) after Medicare Part D was implemented (95% confidence interval, -0.11 to -0.09; P < .001). Benzodiazepine use remained stable in the partial-supplemental- and complete-supplemental-coverage states. Hazard ratios for incident hip fracture were 1.60 (95% confidence interval, 1.05 to 2.45; P = .03) in the no-supplemental-coverage state after Medicare Part D implementation and 1.17 (95% confidence interval, 0.93 to 1.46; P = .18) in the partial-supplemental-coverage states, relative to complete-supplemental-coverage states. CONCLUSION: Supplemental drug coverage exclusion policies affect the medication use of nursing home residents and may not decrease their fracture risk.Source
Arch Intern Med. 2010 Apr 26;170(8):693-8. Link to article on publisher's siteDOI
10.1001/archinternmed.2010.57Permanent Link to this Item
http://hdl.handle.net/20.500.14038/37087PubMed ID
20421554Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1001/archinternmed.2010.57