Impact of Medicare Drug Coverage on Antidepressant Quality and Outcomes

医疗保险药物承保对抗抑郁药物质量和结果的影响

基本信息

批准号：
7655301
负责人：
Sebastian G. Schneeweiss
金额：
$ 39.38万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-08-29 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7655301
关键词：
Accident and Emergency department Accounting Address Admission activity Affect American Anti-Cholinergics Antidepressive Agents Area Characteristics Charge Clinical Cognitive Comorbidity Cost Control Cost Sharing Data Databases Deductibles Development Dose Drug Costs Drug Insurance Drug Kinetics Drug Prescriptions Drug usage Education Effectiveness Elderly Emergency Care Enrollment Evaluation Expenditure Face Formularies Health Health Status Healthcare Systems Hospital Nursing Hospitalization Improve Access Incentives Income Individual Institution Insurance Insurance Carriers Insurance Coverage Lead Light Logic Low income Measures Medicaid Medicare Mental Health Modeling Monitor National Institute of Mental Health Non-Prescription Drugs Nursing Homes Outcome Patient Self-Report Patients Pattern Persons Pharmaceutical Preparations Pharmacists Pharmacodynamics Pharmacologic Substance Pharmacotherapy Pharmacy facility Physicians Play Policies Policy Maker Population Principal Investigator Publications Published Comment Quality Indicator Recommendation Research Research Personnel Resources Role Savings Series Services Stigmata Subgroup Suicide Surveys System Time Treatment Protocols Uncertainty United States Agency for Healthcare Research and Quality Visit age group age related base beneficiary cost cost effectiveness depressed depression design economic impact economic outcome exhaust experience health economics improved interest meetings older patient payment prescription drug costs pressure programs routine practice service intervention simulation social stigma symposium time use trend

项目摘要

DESCRIPTION (provided by applicant): Although antidepressants are the mainstay of treatment for depressed elderly, regimens are often problematic and undermined by high prescription drug costs. The new Medicare drug benefit represents an unprecedented opportunity to address these costs; however there are enormous pressures to contain expenditures by patient cost-sharing. Medication Therapy Management (MTM) programs will also be administered by pharmacists. It is unclear how these drug coverage changes, cost-containment strategies, and MTM programs will impact antidepressant use, quality, health, and economic outcomes in extremely vulnerable elderly with depression. After careful consideration of all reviewer comments of our first submission, we propose a multi-faceted approach using controlled time-series analyses of several large, representative databases, to shed light on the following Medicare drug coverage impacts: - Immediate changes in antidepressant use, including in important subgroups (e.g., with no prior drug coverage) and time periods (e.g., "Doughnut Holes" between initial coverage and catastrophic coverage). - Changes in antidepressant prescribing quality and whether any impacts differ depending upon the type of drug cost-sharing measures used? - Impacts on health outcomes experienced by antidepressant users, including the need for emergency care, hospitalizations, and nursing home admissions - Impacts on the most vulnerable elderly subgroups, such as those with low incomes, poor health status and functioning, and specific comorbidities. - Effectiveness and cost-effectiveness of MTM programs on elderly antidepressant users - Development of a policy simulation program to help policy makers predict the impacts of cost- containment measures on seniors who use antidepressants - Dissemination of results and recommendations to policy makers at the federal and state levels. Only with such information can necessary adaptations (e.g., to formulary, cost-sharing, and MTM programs) be made to improve the quality and outcomes of pharmacotherapies in susceptible and traditionally under-served elderly with depression.

描述（由申请人提供）：尽管抗抑郁药是老年人抑郁症的治疗中的主要手段，但治疗方案通常是有问题的，并且因高处方药成本而破坏。新的Medicare药物福利代表了解决这些费用的前所未有的机会；但是，由于患者成本分担，有巨大的压力，要遏制支出。药物治疗管理（MTM）计划也将由药剂师管理。目前尚不清楚这些药物覆盖范围的变化，成本控制策略以及MTM计划将如何影响抗抑郁药的使用，质量，健康和经济成果，这是抑郁症的极脆弱的老年人。在仔细考虑了我们第一次提交的所有审阅者评论之后，我们提出了一种多方面的方法，使用几个大型代表性数据库的受控时间序列分析，以阐明以下Medicare药物覆盖范围的影响： - 抗抑郁药的立即变化，包括重要的亚组（例如，没有先前的药物覆盖率）和时间段（例如，初始覆盖范围和灾难性覆盖率之间的“甜甜圈孔”）。 - 抗抑郁药的规定质量的变化以及是否有任何影响因使用的药物成本分担措施的类型而有所不同？ - 对抗抑郁用户所经历的健康成果的影响，包括需要紧急护理，住院和疗养院入院 - 对最脆弱的老年亚组的影响，例如收入低，健康状况和功能差以及特定合并症的负责人。 - MTM计划对老年抗抑郁用户的有效性和成本效益 - 制定政策模拟计划，以帮助决策者预测使用抗抑郁药的老年人的成本遏制措施的影响 - 将结果和建议传播给联邦和州一级的政策制定者。只有使用此类信息才能进行必要的适应（例如，制定成本分担和MTM计划），以提高易感性和传统服务不足的老年人抑郁症的药物治疗的质量和结果。