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    Medicare part D's exclusion of benzodiazepines and fracture risk in nursing homes

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    Authors
    Briesacher, Becky A.
    Soumerai, Stephen B.
    Field, Terry S.
    Fouayzi, Hassan
    Gurwitz, Jerry H.
    UMass Chan Affiliations
    Department of Medicine, Division of Geriatric Medicine
    Meyers Primary Care Institute
    Document Type
    Journal Article
    Publication Date
    2010-04-28
    Keywords
    Accidental Falls
    Aged
    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
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    Link to Full Text
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907144/pdf/nihms-211456.pdf
    Abstract
    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 site
    DOI
    10.1001/archinternmed.2010.57
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37087
    PubMed ID
    20421554
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1001/archinternmed.2010.57
    Scopus Count
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