Study finds widespread disparities in medication use

Dartmouth College Atlas Project releases first study on prescriptions

LEBANON, N.H. — Medicare beneficiaries' use of medications — both effective and risky — varies widely across different regions of the United States, according to a new report.

The report, conducted by researchers at Dartmouth College as part of the Dartmouth Atlas Project, is the first report from the project on prescriptions. The researchers also found that the health status of a region's Medicare population accounts for less than one-third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether practice cultures in different regions explain differences in the quality and quantity of prescription drug use.

"There is no good reason why heart attack victims living in Ogden, Utah, are twice as likely to receive medicine to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas, but this inconsistency reflects the current practice of medicine in the United States," lead author and Dartmouth Institute for Health Policy and Clinical Practice professor Jeffrey Munson said.

The report examines how prescription drugs are used by patients of Medicare Part D, which had 37 million enrollees last year, dividing the country into 306 regional healthcare markets and examining variations among them in the quantity and quality of prescription drug use, spending and branded drug use. It then divides prescription use into three categories: drug therapies proven to be effective for heart attack, diabetes or broken-bone patients; discretionary medications with less clear benefits, but usefulness for some patients; and potentially harmful medications for which risks generally outweigh benefits.

"We need to learn from regions that consistently provide high-quality care and focus attention on regions that appear to offer the worst of both worlds: high-risk and discretionary medications and, in relative terms, low use of effective drug therapies," co-author and fellow Dartmouth Institute professor Nancy Morden said.

The report found disparities in how many prescriptions Medicare Part D beneficiaries filled across regions: Patients in Miami filled an average of 63 30-day prescriptions in 2010, while those in Grand Junction, Colo., filled 39. Lexington, Ky., patients filled 59, while Albuquerque, N.M., patients filled 40. The national average was 49 prescriptions.

When prescriptions were broken down based on effective, discretionary and potentially harmful drugs, the study found, for example, that 91.3% of heart attack patients in Ogden filled a prescription for a statin in the seven to 12 months after hospital discharge, compared with 44.3% in Abilene. For potentially harmful drugs, 43% of patients in Alexandria, La., received at least one high-risk medication, compared with the 14% in Rochester, Minn.

Spending on prescriptions by the Part D program averaged $2,670 per beneficiary, with a high of $4,738 in Miami and a low of $1,770 in St. Cloud, Minn. Overall, 26.3% of prescriptions were filled as branded drugs, with patients in Manhattan, 36% of whom used generics, more than twice as likely to fill a prescription with a branded drug as the 16.5% of patients in La Crosse, Wis.

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