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dc.contributor.authorBriesacher, Becky A.
dc.contributor.authorSoumerai, Stephen B.
dc.contributor.authorField, Terry S.
dc.contributor.authorFouayzi, Hassan
dc.contributor.authorGurwitz, Jerry H.
dc.date2022-08-11T08:09:23.000
dc.date.accessioned2022-08-23T16:28:44Z
dc.date.available2022-08-23T16:28:44Z
dc.date.issued2010-04-28
dc.date.submitted2011-12-30
dc.identifier.citationArch Intern Med. 2010 Apr 26;170(8):693-8. <a href="http://dx.doi.org/10.1001/archinternmed.2010.57">Link to article on publisher's site</a>
dc.identifier.issn0003-9926 (Linking)
dc.identifier.doi10.1001/archinternmed.2010.57
dc.identifier.pmid20421554
dc.identifier.urihttp://hdl.handle.net/20.500.14038/37087
dc.description.abstractBACKGROUND: 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=20421554&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907144/pdf/nihms-211456.pdf
dc.subjectAccidental Falls
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAnti-Anxiety Agents
dc.subjectBenzodiazepines
dc.subjectCohort Studies
dc.subjectConfidence Intervals
dc.subjectDrug Utilization
dc.subjectFemale
dc.subjectHip Fractures
dc.subject*Homes for the Aged
dc.subjectHumans
dc.subjectIncidence
dc.subjectInsurance Coverage
dc.subjectLegislation, Drug
dc.subjectLongitudinal Studies
dc.subjectMale
dc.subjectMedicare Part D
dc.subjectMultivariate Analysis
dc.subject*Nursing Homes
dc.subjectProportional Hazards Models
dc.subjectReference Values
dc.subjectRisk Assessment
dc.subjectUnited States
dc.subjectGeriatrics
dc.subjectHealth Services Research
dc.subjectPrimary Care
dc.titleMedicare part D's exclusion of benzodiazepines and fracture risk in nursing homes
dc.typeJournal Article
dc.source.journaltitleArchives of internal medicine 20876418
dc.source.volume170
dc.source.issue8
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/meyers_pp/469
dc.identifier.contextkey2426126
html.description.abstract<p>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.</p> <p>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).</p> <p>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.</p> <p>CONCLUSION: Supplemental drug coverage exclusion policies affect the medication use of nursing home residents and may not decrease their fracture risk.</p>
dc.identifier.submissionpathmeyers_pp/469
dc.contributor.departmentDepartment of Medicine, Division of Geriatric Medicine
dc.contributor.departmentMeyers Primary Care Institute
dc.source.pages693-8


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