Abstract:
BACKGROUND:Disabled Americans who qualify for Medicare coverage typically have multiple chronic conditions, are highly dependent on effective drug therapy, and have limited financial resources, putting them at risk for cost-related medication nonadherence (CRN). Since 2006, the Part D benefit has helped Medicare beneficiaries afford medications. OBJECTIVE:To investigate recent national trends in medication affordability among this vulnerable population, stratified by morbidity burden. DESIGN AND SUBJECTS:We estimated annual rates of medication affordability among nonelderly disabled participants in a nationally representative survey (2006-2011, n=14,091 person-years) using multivariate logistic regression analyses. MEASURE:Survey-reported CRN and spending less on other basic needs to afford medicines. RESULTS:In the 6 years following Part D implementation, the proportion of disabled Medicare beneficiaries reporting CRN ranged from 31.6% to 35.6%, while the reported prevalence of spending less on other basic needs to afford medicines ranged from 17.7% to 21.8%. Across study years, those with multiple chronic conditions had consistently worse affordability problems. In 2011, the prevalence of CRN was 37.3% among disabled beneficiaries with ≥ 3 morbidities as compared with 28.1% among those with fewer morbidities; for spending less on basic needs, the prevalence was 25.4% versus 15.7%, respectively. There were no statistically detectable changes in either measure when comparing 2011 with 2007. CONCLUSIONS:Disabled Medicare beneficiaries continue to struggle to afford prescription medications. There is an urgent need for focused policy attention on this vulnerable population, which has inadequate financial access to drug treatments, despite having drug coverage under Medicare Part D.
journal_name
Med Carejournal_title
Medical careauthors
Naci H,Soumerai SB,Ross-Degnan D,Zhang F,Briesacher BA,Gurwitz JH,Madden JMdoi
10.1097/MLR.0000000000000205subject
Has Abstractpub_date
2014-11-01 00:00:00pages
951-6issue
11eissn
0025-7079issn
1537-1948journal_volume
52pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract::Sixty-eight interviews of hospitalized patients by freshmen medical students were examined for common response patterns. Response profiles were constructed for each medical student and subjected to cluster analysis. Four common response patterns were identified: Questioning Facilitators, Declaring Facilitators, Elabor...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198611000-00002
更新日期:1986-11-01 00:00:00
abstract:BACKGROUND:The major fault with existing reimbursement systems lies in their failure to discriminate for the effectiveness of stay, both when paying per day and when paying per episode of treatment. OBJECTIVES:We sought to define an average length of effective stay and recovery trends by impairment category, to design...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/01.mlr.0000173568.67805.70
更新日期:2005-09-01 00:00:00
abstract::A population-based approach was used to analyze the utilization patterns of hospital care by Manitoba residents during the fiscal year 1991/1992. Patterns were analyzed for eight administrative regions, with use assigned to the patient's region of residence, regardless of the location of the hospitalization. Regional ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199512001-00008
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVES:Although information technology (IT) may improve efficiency and quality of patient care, the adoption of clinical IT by physicians has been limited. This study investigates the relationships between physician practice revenue and use of clinical IT. RESEARCH DESIGN:We undertook a cross-sectional analysis of...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000241089.98461.e5
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVES:To contrast the interpretations of treatment effect estimates using risk adjustment and instrumental variable (IV) estimation methods using observational data when the effects of treatment are heterogeneous across patients. We demonstrate these contrasts by examining the effect of breast conserving surgery p...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318070c069
更新日期:2007-10-01 00:00:00
abstract::Cataract surgery is the most frequently performed surgical procedure on Medicare beneficiaries, with an annual cost to the Medicare program of more than $3.4 billion. In this study, the relationship between demographic, environmental, and provider-related factors, and the likelihood that cataract surgery will be perfo...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199501000-00008
更新日期:1995-01-01 00:00:00
abstract::This study examines practice mobility among young physicians, based on a large nationwide 1987 survey of physicians under age 40 years and in their second through fifth years of practice. Averaged across all physicians, there is a 10% to 12% chance of changing practices for each of the first 3 years, and about one in ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199110000-00004
更新日期:1991-10-01 00:00:00
abstract:BACKGROUND:Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. OBJE...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/mlr.0b013e3181cafbe3
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:Spinal mobilization and manipulation are 2 therapies found to be generally safe and effective for chronic low back pain (CLBP). However, the question remains whether they are appropriate for all CLBP patients. RESEARCH DESIGN:An expert panel used a well-validated approach, including an evidence synthesis an...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001108
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVES:Reliability and validity are as necessary for predrafted advance directive forms as they are for all clinical assessment instruments. Performance of predrafted advance directive forms with both lay persons and clinicians is relevant. Evidence relating to test- retest reliability, content validity, and criter...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199610000-00006
更新日期:1996-10-01 00:00:00
abstract:OBJECTIVE:To examine longitudinal changes in Medicare-eligible veterans' reliance on the Department of Veterans Affairs (VA) healthcare system for primary and specialty care over 4 years. METHODS:We merged VA administrative and Medicare claims data to examine outpatient use during fiscal years (FY) 2001 to 2004 by 15,...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31822396c5
更新日期:2011-10-01 00:00:00
abstract::The second phase of the ADHC Evaluation Study was designed to assess ADHC provided under contract by community ADHC programs. Outcomes for the 163 patients enrolled in this prospective cohort evaluation were compared with those of patients assigned to ADHC provided directly by VA (VA-ADHC) and customary care in the ra...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:Data suggest that differences in patient preferences may account for racial disparities in the use of medical interventions. Racial disparities have also been noted in outcomes and the delivery of healthcare services in chronic disease. Whether treatment preferences in chronic disease differ by race is not k...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31818af829
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Evidence that medical error is a systemic problem requiring systemic solutions continues to expand. Developing a "safety culture" is one potential strategy toward improving patient safety. A reliable and valid self-report measure of safety culture is needed that is both grounded in concrete behaviors and is ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/01.mlr.0000244635.61178.7a
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Managed care is the dominant form of health insurance in the United States, covering millions of children. Little is known about whether inner-city parents adequately understand managed care's complex definitions and rules. OBJECTIVE:The objective of this study was to examine managed care knowledge and prac...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000118708.21532.de
更新日期:2004-04-01 00:00:00
abstract::The purpose of this study was to develop a "time-insensitive" predictive instrument (TIPI) for acute hospital mortality due to congestive heart failure. In Phase 1, based on prospectively collected data on 401 congestive heart failure patients among 5,773 study patients who presented to six New England hospitals over ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/00005650-199410000-00005
更新日期:1994-10-01 00:00:00
abstract::In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199205001-00004
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not eas...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:2001-08-01 00:00:00
abstract:OBJECTIVE:To compare trends in office-based treatment of mental disorders between Hispanics and non-Hispanics. DESIGN, SETTING, AND PARTICIPANTS:Analysis of a nationally representative sample of visits to office-based physicians conducted between 1993 and 2002 (N = 251,905). Visits were grouped into 3 discrete time pe...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3180ca95d3
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services. RESEARCH DESIGN AND METHODS:The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the E...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000132397.49094.b3
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:Estimating population-level obesity rates is important for informing policy and targeting treatment. The current gold standard for obesity measurement in the United States-the National Health and Nutrition Examination Survey (NHANES)-samples <0.1% of the population and does not target state-level or health s...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000693
更新日期:2017-06-01 00:00:00
abstract::Patients often receive medical care from many different providers. Consequently, the various episodes of care may not be integrated into a meaningful whole, and the quality of care may suffer. Before this possibility can be evaluated, it is necessary to develop a measure of the integrating process. The authors studied...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198405000-00004
更新日期:1984-05-01 00:00:00
abstract:BACKGROUND:Continuity of the relationship between patients and primary care providers (PCPs) is an important component of care from the consumer perspective that may be affected by variation in cost containment strategies within managed care. OBJECTIVE:To evaluate the effects of cost containment strategies on the cont...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200110000-00005
更新日期:2001-10-01 00:00:00
abstract:BACKGROUND:Millions of traumatized refugees worldwide have resettled in the United States. For one of the largest, the Cambodian community, having their mental health needs met has been a continuing challenge. A multicomponent health information technology screening tool was designed to aid provider recognition and tre...
journal_title:Medical care
pub_type: 杂志文章,随机对照试验
doi:10.1097/MLR.0000000000001036
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:Nearly 38 million Americans have hearing loss. Understanding how sensory deficits such as hearing loss, which limit communication, impact satisfaction has implications for Medicare value-based reimbursement mechanisms. The aim of this study was to characterize the association of functional hearing...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001419
更新日期:2021-01-01 00:00:00
abstract::A factorial design randomized controlled trial to test several clinically feasible strategies primary-care practitioners may use in routine practice to increase patient participation in occult blood testing for colorectal cancer is reported. Three compliance-enhancing intervention strategies (physician/nurse talk, and...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-198610000-00004
更新日期:1986-10-01 00:00:00
abstract:OBJECTIVES:We conducted a theoretically guided study of access to inpatient or residential treatment among a probability sample of homeless adults with alcohol or drug use disorders in Houston, Texas. METHODS:This study used a cross-sectional, retrospective design with data collected from a multistage random sample of...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200111000-00003
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:Patients have longer lengths of hospital stay (LOS) in VA medical centers than in the general health care system. OBJECTIVE:The objective of this study was to determine whether resource use and outcome differences between VA and non-VA inpatient rehabilitation facilities remain after controlling for patient...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200102000-00003
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:Little is known about the medical care resources devoted to diagnosing and treating cancer-related symptoms before a definitive cancer diagnosis. Previous research using SEER-Medicare data to measure incremental costs and utilization associated with cancer started with the date of diagnosis. We hypothesized ...
journal_title:Medical care
pub_type: 杂志文章,随机对照试验
doi:10.1097/MLR.0b013e3182731277
更新日期:2013-04-01 00:00:00
abstract::This study was initiated to determine the extent of hospital capacity reduction in large U.S. cities. In addition, hospital bed and service additions were analyzed. Study data indicate that between 1976 and 1978 more than 5,000 beds were closed in the 36 cities surveyed. This constitutes 2.7% of total hospital beds in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198007000-00004
更新日期:1980-07-01 00:00:00